population and development report - issue no. 8 prospects
TRANSCRIPT
0
E/ESCWA/SDD/2017/3
Population and Development Report - Issue No. 8
Prospects of Ageing with Dignity in the Arab Region
United Nations
Beirut
1
Introduction
Ageing in Dignity in the Arab region
The Arab region has one of the fastest growing populations in the world. Constituting around 5.5 per
cent of the world’s population, the number of persons living in the Arab region has almost tripled
since 1970, from 120 million to more than 400 million in 2017. Over the same period, the population
of persons aged 60 years and above has more than quadrupled, increasing from approximately 7
million in 1970 to 29 million in 2017. The proportion of the population of older persons is expected
to continue to increase, leading countries in the Arab region to experience population ageing when
older people become a proportionately larger share of the total population. Currently, older persons
above the age of 60 currently represent 7 per cent of the total population living in the Arab region.
By 2030, 49.6 million will be older persons and by 2050 100 million, or 15 per cent, will be older
persons, with women comprising more than half.
Population ageing is occurring largely as a result of positive development gains. Declining fertility
and mortality rates and increasing life expectancy have resulted in growing proportions of working-
age populations (ages 15-64) and older persons (60 years and above) in most Arab countries.
However, population ageing is occurring at different rates across the countries in the Arab region due
to several reasons, including differences in economic resources, demographic and socio-political
priorities, migration patterns, and political stability.1 Nevertheless, most Arab countries have been
experiencing an overall increase in the proportion of older persons.
These demographic changes have created two simultaneous demographic trends. On the one hand,
the region is experiencing a “youth bulge,” which researchers and policy-makers are seeking to
address to maximize the potential benefits and reduce potential negative effects. This focus on youth
has occurred alongside the “silent ageing process,” which a few countries in the region have already
begun to witness.2
The transition period during which Arab populations will evolve from “ageing” to “aged” is estimated
to range from 13 to 40 years; whereas in Europe, countries experienced this transition over a range
of 50 to 150 years. By 2050, more than 14 per cent of the population in most Arab countries will be
older persons. Some countries, such as Lebanon and Tunisia, will reach this proportion even before
2040. The rapid ageing process witnessed by many countries creates an unprecedented urgency to
address the consequences of the demographic transitions. As a result, governments and societies in
the Arab region will have to adapt much more rapidly to this phenomenon than their developed
counterparts. Governments need to adopt holistic strategies and implement policies and programs to
ensure the social, economic, psychological and physical wellbeing of older persons.
1 Saxena, P.C “Ageing and Age-Structural Transition in the Arab Countries: Estimated Period of
Demographic Dividends and Economic Opportunity” IUSSP 2009 2 Palloni, A., Peláez, M. and Wong, R. (2006) Introduction: Aging among Latin American and Caribbean Populations.
Journal of Aging and Health, 18, 149-156. http://dx.doi.org/10.1177/0898264306286766
2
Older persons’ potential to age in dignity is threatened if current socio-economic and security
conditions persist. Women, who often live longer than men, are also more vulnerable as they become
older, given low education and employment rates, weak social protection systems, and are more
affected by long-term and chronic diseases. To support older persons’ potential to age in dignity, a
paradigm shift in how governments and societies view older persons is required. The view of older
persons as a burden, dependent on state and family assistance, needs to be replaced with one that
values older persons as active citizens who can be engaged in the different socio-economic activities
and who make valuable contributions to their families and communities. For this shift to materialize,
governments must provide adequate health care, social security, and venues for meaningful socio-
economic participation.
In order to prepare governments to be capable of addressing these needs, more specific data on older
persons is required, including data disaggregated by age and sex. Presently, much census and
population data is limited to a single age bracket of age 60 plus, without offering much detail about
the lives of individuals in different age ranges above age 60. Significant improvement in data
collection and sharing are required to build evidence-based strategies, policies, and programs for older
persons.
Now more than ever, governments are prompted to take action to “leave no one behind” as they
pledge to achieve the 2030 Agenda. It is thus not only an ethical imperative to ensure that ageing in
dignity is possible for all persons, but also a precondition to achieving inclusive sustainable
development. The universality and interdependence of the sustainable development goals (SDGs)
necessitate the adoption of a holistic approach to ageing that incorporates different dimensions of the
life-course perspective. Achieving the SDGs also requires the engagement of all stakeholders,
including government institutions, civil society, the private sector, among others.
In addition to the 2030 Agenda, two policy frameworks focus on the nexus of the rights of older
persons and development and offer guidance on addressing ageing issues, namely the Programme of
Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994
and the Madrid International Plan of Action on Ageing (MIPAA) of the Second World Assembly on
Ageing held in Madrid in 2002.
Furthermore, the Arab region has been proactive in the focus on ageing for almost two decades. The
Arab Plan of Action on Ageing (APAA) was developed in February 2002 in preparation for the
Second World Assembly on Ageing. Since then, a series of national and regional efforts have been
made to increase the visibility and centrality of older persons issues across the region.
It is in this context that the eighth issue of the Population and Development Report (PDR) focuses on
exploring the prospects of ageing with dignity in the Arab region. Anchored in a human rights
approach, the report affirms the principle of “leaving no one behind” from the 2030 Agenda for
Sustainable Development and adheres to all global frameworks and regional mandates to protect the
3
human rights, wellbeing, and development of older persons. in the horizon of 2030, the target year to
achieve the Sustainable Development Goals (SDGs), and beyond.
The report argues that given the fast-paced ageing phenomenon in the region, swift interventions as
well as medium and long-term planning are needed to ensure that people in the region can age with
dignity. To support this argument, the report uses a mixed methods approach to examining
demographics and socio-economic trends, incorporating quantitative statistical analysis of national
census and surveys, United Nations data, and in-depth qualitative analysis relying on primary and
secondary data sources.
The first chapter presents demographic trends leading to age structure transitions in Arab countries.
It illustrates past and future trends in population size and growth rates, as well as fertility, mortality
and migration patterns as determinants of age structure composition. The analysis shows the
overarching trend of population ageing in the region, as well as trends in the region and by country.
The second chapter examines the socio-economic conditions of older persons in the Arab region,
including interrelated development issues that affect their wellbeing and protection from
vulnerability, such as education and learning, employment, pension coverage, health, and security.
The analysis of the socio-economic conditions of older persons aims to assess their situation,
resources and protections provided by the State, civil organizations and families, in order to bring to
the fore the experiences, challenges and risks they face presently and in the future.
Chapter three discusses the present trends in living arrangements of older persons as an important,
but not singular, mode of social protection for older persons. Chapter three then specifically focuses
on Two-way intergenerational support through a case study in Lebanon, the fastest ageing society in
the Arab region. The case study offers an in-depth analysis emphasizing the effect of this support on
vulnerability of older persons. It also highlights both the tangible and intangible contributions of older
persons to their families and societies that often go unnoticed and underappreciated. This chapter
acknowledges the centrality of the family as the most-valued institution providing care for older
persons, while also showing that this method of care is becoming vulnerable to increased poverty and
other changing care-giving dynamics among family members. Furthermore, this section shows how
younger generations today may rely on the monetary and non-monetary support of older persons and
advocates for making this important aspect of exchange visible.
Chapter Four builds on the current demographic trends and future prospects of population ageing in
the region to provide an evidence-based projection of the needs of older persons in the Arab region
by 2030 and 2050. Given some older persons’ limited access to education, health care, pension
coverage and family support, and the expected future demographic, social and economic changes, the
chapter gives an insight into the needs of older people in the coming decades.
Based on the challenges that older persons are experiencing in the present and future, the final
chapter of the report proposes a set of policy recommendations that can guide policymakers to
anticipate and address the unique needs of older persons in a timely, inclusive and effective manner.
4
CHAPTER 1
DEMOGRAPHIC OVERVIEW
AGEING IN THE ARAB REGION: TRENDS,
PATTERNS, AND PROSPECTS
DRAFT – NOT FOR CIRCULATION
5
The Arab region is currently experiencing a demographic transition representing a change from a
society with high fertility and high mortality, to one that is experiencing reduced fertility and
mortality rates. This transition is leading to a shift in the population’s age structure, including an
increase in the number of youth and working-age adults, as well as an increased number and
proportion of older persons, which leads to population ageing.
While most countries in the Arab region will undergo the transition to an ageing population within
the next few decades, countries in the region will experience this change at different rates. Some
countries, such as Lebanon, Tunisia and Morocco, will soon reach advanced stages of the
demographic transition, while others, such as Mauritania, Somalia, and Sudan, are not likely to
experience it population ageing until after 2050. However, in nearly half of the Arab countries, the
ageing process is taking place at a fast or moderate rate.
This chapter analyzes past and future demographic trends in 22 Arab countries during the period of
1970 to 2050 and to demonstrate possible determinants and consequences of population ageing.
Following a discussion of the definitions, methodology and data sources used, proceeds to describe
and analyze the current and foreseen demographic trends, namely the ones related to population size
and growth, fertility, mortality, and human mobility. Based on the data analysis presented, the chapter
continues to discuss the change in the population age structure in countries across the region, with a
focus on the ageing phenomenon. The chapter then presents and discusses data on dependency ratios
and family formation, which will contribute to the analysis of the socio-economic conditions of older
persons in the following chapters. Finally, the chapter concludes with the discussion of some of the
main findings and conclusions.
A. Definitions, sources and methodology
Population ageing describes the demographic phenomenon whereby older individuals become a
proportionately larger share of total population.3 This chapter defines “older persons” as the
population over the age of 60, consistent with the methodology used by United Nations Department
of Economic and Social Affairs (UN DESA)4. While this report defines older persons as over the age
of 60, it is important to note that some studies have used age 65 and above.5
Two main types of indicators will be used to describe the ageing process: the proportion of the
population aged 60 and above relative to the total population and dependency ratios. The total
dependency ratio is the sum of the youth dependency ratio and the old-age dependency ratio: the
youth dependency ratio is the number of persons aged 0 to 14 years per one hundred persons aged 15
to 60 years; the old-age dependency ratio is the number of persons 60 years and over per one hundred
persons aged 15-60 years.
3 United Nations. Department of Economic and Social Affairs, Population Division (2001) World Population Ageing:
1950-2050 (2002ST/ESA/SER.A/207). 4 Population ageing (or demographic ageing) is defined by the United Nations as “the process whereby older individuals
become a proportionately larger share of total population” (United Nations. Department of Economic and Social
Affairs, Population Division (2001) World Population Ageing: 1950-2050 (2002ST/ESA/SER.A/207) 5 The old age definition is often linked to the changes observed in social roles and activities, and to the retirement age.
The old age cut-off is also associated with a change in mental and physical capacities. It varies from one context to
another and 60 or 65 are usually the two cut-off ages that are most used. For example, WHO used the threshold of 65
years in 2011 to define older persons: WHO. National Institute on Aging, National Institutes of Health. (2011) “Global
Health and Aging” NIH Publication no. 11-7737. http://www.who.int/ageing/publications/global_health.pdf
6
Data on demographic trends used in the present chapter are taken from the 2017 Revision of World
Population Prospects, the official United Nations world population estimates and projections. These
data consist of estimates and projections of population size, structured by age and sex, and population
determinants (fertility, mortality and net migration), prepared biennially by the Population Division
of the United Nations, Department of Economic and Social Affairs (DESA). The World Population
Prospects data provides the standard and consistent set of population figures used throughout the
United Nations system as the basis for activities requiring population information. For the period
1970 to 2015, population counts by age and sex are built on periodic censuses, while “the relevant
estimates of demographic components were taken directly from national statistical sources, or were
estimated by staff of the Population Division when only partial or poor-quality data were available.
Necessary adjustments were made for deficiencies in age reporting, under-enumeration, or
underreporting of vital events”.6
The data for 2015 to 2050 are projections, which are calculated based on assumptions regarding
determinants of population change (fertility, mortality, and international migration). Therefore, they
are subject to a certain degree of uncertainty, which increases as we move further away from the base
year, 2015, especially at the country level.7
This chapter uses the medium variant population projections through the year 2050. The medium
variant represents the median of several thousand projected trajectories of specific demographic
components for each country. The medium variant in United Nation’s population projections assumes
a decline in fertility rates in patterns similar to what has occurred in other countries and regions of
the world. However, this assumption may not apply to all Arab countries given recent data that show
an increase in fertility levels after periods of decreased fertility in some countries, such as Egypt,
Tunisia and Algeria. Furthermore, the current conflict and migration trends in some countries of the
region may impact demographic change. The use of the medium variant, as opposed to the low, high,
or constant-fertility variants, will hopefully yield projections that are closest to the development of
population structures across the region. Chapter 4 discusses the uncertainty of demographic
projections on population ageing process in further detail.
Demographic data were analyzed for each of 22 Arab countries. To increase the analytic efficacy of
this chapter, the countries are grouped into three major categories according to the rate of prospective
ageing in their respective populations from 1970 to 2015. The first category corresponds to countries
that have witnessed a “fast rate of ageing”:8 Lebanon, Tunisia, Morocco and Algeria. The second
category includes countries that will experience a “moderate rate of ageing”9: Djibouti, Egypt, Libya,
Jordan, Kuwait, Syria, and the GCC countries. The final category of countries includes those with
“slow rate of ageing,”10 which comprise of Comoros, Iraq, Mauritania, State of Palestine, Somalia,
the Sudan and Yemen.
6 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population
Prospects: The 2017 Revision, Methodology of the United Nations Population Estimates and Projections,
Working Paper No. ESA/P/WP.242. 7 Detailed information on the uncertainty bounds for different components of the demographic trends at the country level
is available on the website of the Population Division, www.unpopulation.org.
8 Countries that will begin the ageing transition (population aged 65 years or older move from 7 to 14 per cent of the
population) between 2000 and 2030.
9 Countries that will begin the ageing transition between 2030 and 2060. 10 Countries that will begin the ageing transition after 2060.
7
B. Population size and growth
Population growth refers to the increase in the number of inhabitants of a given place. Trends in
population growth at the regional and national level are important for policymakers to understand in
order to prepare for all the various development impacts of population change. Population changes
have profound implications for the economy, labour market, pensions, social protection, education,
housing, sanitation, water, energy, food, consumption, migration, health and social care, and
environment among others. Population growth can occur at different rates according to variations in
fertility, mortality, and migration. The trends of these three causal factors also determine the extent
of population ageing, which is the focus of this chapter Therefore, this section presents the baseline
demographic data upon which analysis for population ageing can take place.
The data show that population growth is very high
across the Arab region, albeit at varying rates across
countries. Since 1970, the total population in the Arab
region has more than tripled. From 123.5 million in
1970, the population size increased to 284.1 million in
2000 and to over 398.5 million in 2015. This figure
means that the Arab region hosts around 5.4 per cent
of the world’s population, compared to 3.3 per cent in 1970 and 4.6 per cent in 2000.
Despite the significant increase in population size, the annual rate of growth has been slowing
recently, with a decrease from 2.82 per cent between 1970-2000 to 2.28 per cent during 2000-2015.
However, the Arab region’s population has grown more rapidly than the global average (1.70 per cent
from 1970-2000 and 1.23 per cent from 2000-2015) and the less developed regions11 (2.05 per cent
from 1970-2000 and 1.43 per cent from 2000-2015).12
Analysis of projected data for 2015-2050 reveals that these demographic trends are expected to
continue. The Arab region’s population will continue to increase in size, growing at a rate faster than
that of the global average. The region’s population is expected to grow to over 520.7 million by 2030
and to 676.4 million by 2050. This growth will occur at a rate of about 1.52 per cent per year, which
is slower than the rate from 1970-2015, but is still faster than that of the anticipated global average,
which is 0.80 per cent. As a result, the region’s proportion of the world population is projected to
increase to 6.9 per cent.
Within the region, population sizes and growth rates are expected to vary greatly across countries. As
figure one shows, by 2050 Egypt will continue to have the largest population in the region, (153.4
million), followed by countries whose population may more than double in size including Iraq (81.5
million), Sudan (80.4 million), Algeria (57.4 million), and Yemen (48.3 million) (see Annex, table 1
for more details).
11 The UN Department of Economics and Social Affairs Population Division defines the “less developed regions” as
comprised of all countries in Africa, Asia (excluding Japan), Latin America and the Caribbean plus Melanesia,
Micronesia and Polynesia. See https://esa.un.org/poppolicy/ExplanatoryNotes.aspx. 12 Growth rates are computed by the author using data from UN Population Division, World Population Prospects: The
2017 Revision, https://esa.un.org/unpd/wpp/DataQuery/.
Since 1970, the size of the
population in the Arab region has
more than tripled Today, more than
one in 20 people in the world live in
the Arab region.
8
Source: United Nations, World Population Prospects (2017). Medium Variant.
Figure 2 demonstrates the variation of growth rates across countries in the Arab region across ten
year periods from 1970 to 2050. It reveals three categories of ageing countries: Figure 2A for
countries with a “fast rate of ageing”, Figure 2B for countries with a “moderate rate of ageing” and
Figure 2C for countries with a “slow rate of ageing”. The variation in growth rates can likely be
attributed to variation in socio-economic development, instability and armed conflict, and
international migration and refugee movements.13 (See Annex table 2 for more details).
13 Saxena ,P.C “Ageing and Age-Structural Transition in the Arab Countries: Estimated Period of
Demographic Dividends and Economic Opportunity” IUSSP 2009
0 20000 40000 60000 80000 100000 120000 140000 160000 180000
Egypt
Algeria
Sudan
Iraq
Morocco
Saudi Arabia
Yemen
Syrian Arab Republic
Somalia
Tunisia
Jordan
United Arab…
Libya
Lebanon
State of Palestine
Oman
Mauritania
Kuwait
Qatar
Bahrain
Djibouti
Comoros
Figure 1: Population Size by Country in the Arab Region (in thousands): 1970, 2015, and 2050
2050
2015
1970
9
-1.50
-0.50
0.50
1.50
2.50
3.50
4.50
1970 1980 1990 2000 2010 2020 2030 2040 2050
Figure 2A: Annual Demographic Growth Rate (in %) of Arab Countries with a Fast Rate of Ageing: 1970 until 2050
Tunisia Lebanon Algeria
Morocco All Arab countries State of Palestine
-2.00
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
1970 1980 1990 2000 2010 2020 2030 2040 2050
Figure 2B: Annual Demographic Growth Rate (in %) of Arab Countries with a Moderate Rate of Ageing: 1970 until 2050
Djibouti Egypt Libya
Jordan Kuwait Syrian Arab Republic
All Arab countries Bahrain Oman
Qatar Saudi Arabia United Arab Emirates
10
Source: United Nations, World Population Prospects (2017), Medium Variant.
1. Fertility
Fertility has a significant impact on population growth and
population ageing; therefore, it is important to understand both its
determinants and consequences. Fertility is measured by the
Total Fertility Rate (TFR), which refers to the average number of live
births a woman has over her reproductive life.
The two principal direct determinants of the level of fertility are marriage (age at marriage and
duration of marriage) and birth control (contraception practice). While the Arab region witnessed
very high fertility levels in the past, fertility rates have been steadily declining since the 1980’s in all
countries in the region, except for Somalia. The rising age of marriage in many Arab countries is well
documented as the primary determinant of fertility decline in the region.14 Use of Contraception has
also contributed to this decline.15 This decreasing rate of fertility has been one of the principal causes
of population ageing in the Arab region, except for some Gulf Cooperation Council (GCC) countries
where international migration has also constituted a major component of demographic change.
14 See for example, Rashad, Hoda “The tempo and intensity of marriage in the Arab region: Key challenges and their
implications” DIFI Family Research and Proceedings. Vol. 2015 1, 2.DOI:10.5339/difi.2015.2.
http://www.qscience.com/doi/pdf/10.5339/difi.2015.2 and Roudi-Fahimi F, Kent M. Fertility Declining in the Middle
East and North Africa. Population Reference Bureau; 2008.
http://www.prb.org/Publications/Articles/2008/menafertilitydecline.aspx 15 Women’s need for family planning in arab countries. UNFPA- Population Reference Bureau; 2012.
http://www.prb.org/pdf12/family-planning-arab-countries.pdf
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
1970 1980 1990 2000 2010 2020 2030 2040 2050
Figure 2C: Annual Demographic Growth Rate (in %) of Arab Countrieswith a Slow Rate of Ageing: 1970 until 2050
Comoros Somalia Sudan
Mauritania Iraq State of Palestine
Yemen All Arab countries
Fertility decline is the
main driver of
population ageing in
the Arab region.
11
The decline of total fertility rates in the region has contributed to slower population growth rates. In
the future, most countries in the Arab region will experience declining fertility rates to levels below
replacement level,16 meaning there will be fewer births than there were in the past, causing the
proportion of children to decrease and that of the older population to increase.
As figure 3 shows, the fertility level in 1970 was high in all Arab countries, ranging from 6.2 children
per woman in Egypt to 8.0 in Libya. In addition to these countries with near natural fertility,17
Somalia, Comoros, Algeria, Palestine, Oman, Kuwait, Saudi Arabia, the State of Palestine and the
Syrian Arab Republic each had fertility rates of above 7 children per woman.
Since 1980, according to United Nations estimates, fertility has steadily declined in all Arab countries,
except in Yemen and Somalia. By 2010, only six of the 22 Arab countries had near replacement or
below replacement levels of fertility (Lebanon (1.6); UAE (1.9); Tunisia and Qatar (2.1); Bahrain and
Kuwait (2.2)).
16 Replacement level fertility is the level of fertility at which a population exactly replaces itself from one generation to
the next. It is achieved when the fertility rate amounts to an average of 2.1 children per woman. 17 Natural fertility refers to fertility rates of a population not practicing any form of birth control. It has been estimated
that a woman who is continuously in a sexual union between the ages of 15 and 50 years, not breastfeeding her children,
and not practicing any form of birth control, would bear 15 children on average. Near-natural fertility means with
almost no birth control, but accounts for delayed first union.
1970 1980 1990 2000 2010 2020 2030 2050
Figure 3A: Total Fertility (number of children per woman): 1970-2050
Tunisia
Lebanon
Algeria
Morocco
All Arab countries
12
Source: United Nations, World Population Prospects (2017), Medium Variant. Note: Total fertility rate for the whole Arab countries is computed using population weights.
It should be noted that these trends are not linear. In the Arab countries, fertility rates started to
rapidly decline in the 1980’s and 1990’s, followed by deceleration since the year 2000.
1970 1980 1990 2000 2010 2020 2030 2050
Figure 3B: Total Fertility (number of children per woman): 1970-2050
Djibouti EgyptLibya JordanKuwait Syrian Arab RepublicAll Arab countries BahrainOman QatarSaudi Arabia United Arab Emirates
1970 1980 1990 2000 2010 2020 2030 2050
Figure 3C: Total Fertility (number of children per woman): 1970-2050 Comoros
Somalia
Sudan
Mauritania
Iraq
State of Palestine
Yemen
All Arab countries
13
In the most recent decade, fertility rates have been slowing even further for some countries; yet for a
few others, fertility is rising. The latter situation is referred to as a “demographic counter-transition.”18
Available national data for three Arab countries shows an increase in total fertility rate between 2008
and 2014: from 3 to 3.5 children per woman in Egypt, from 2.4 to 3.2 in Algeria, and from 1.98 to
2.47 in Tunisia. For other countries, fertility remains high (above 4 children per women in 2015):
Somalia, the Sudan, Mauritania, Iraq, the State of Palestine and Yemen.
However, in the future, UN medium variant hypotheses assume that fertility is likely to decline across
all Arab countries., as shown in figure 3. By 2050, the total fertility rate is expected to range between
1.7 and 2.9 children in most countries, with several countries reaching below replacement fertility
levels.
These figures demonstrate that the countries of the Arab region are moving towards ageing
populations at varying rates. The periods of high fertility and high number of births in the 1970s,
followed by a decrease in fertility rates over the past couple of decades, and an increase in life
expectancy, has resulted in an increase in the number and proportion of older persons. This age group
is projected to increase significantly by 2050. Therefore, population ageing can be said to result
mainly from the decline in fertility.
It is worth noting that changes in fertility rates projected for the next thirty years will not have a
significant effect on the size of the population of older persons by 2050 (in terms of absolute numbers)
given that older persons in 30 years are already in their 30’s today, it might however affect their
proportion of total population.
2. Mortality
A decline in mortality rates in the Arab region is also contributing to population growth and
population ageing. People in the region are living longer, especially women, and this trend is expected
to continue, leading to demographic shifts. Improved life expectancy across the developing world has
occurred mainly because child mortality rates have declined over the past four decades. Factors such
as income growth, public spending on basic health services, more hygienic conditions, and better
infrastructure, education, urbanization and food sufficiency have contributed to this decline19 and to
increasing life expectancy at older ages.
a. Life expectancy at birth
From 1970 to 2015, the Arab region has witnessed significant decrease in mortality as measured by
life expectancy at birth, which has increased by the equivalent of 10 hours per day, on average, for
men and women together (or 0.4 years annually). This trend is expected to continue (see table in
annex). Life expectancy at birth will likely improve from 71 years in 2015 to 76.4 years in 2050.
While it was estimated at below 60 years in 16 Arab countries in 1970, in 2015, life expectancy at
birth was still less than 60 years only in Somalia and it was equal to or exceeded 70 years in 15 Arab
countries.
18 Courbage. Y (2017) presentation as panelist at the 55th commission of population and development ECOSOC, 5
AVRIL 2017. https://www.un.org/press/fr/2017/pop1058.doc.htm 19 Iqbal,F. and Kiendrebeogo,Y. (2014) The Reduction of Child Mortality in the Middle East and North Africa.
A Success Story. World Bank Group. Policy Research Working Paper 7023
14
Factors including poverty, conflict, and the re-emergence of certain
infectious diseases such as malaria, tuberculosis and cholera have
contributed to low life expectancy in some countries (Comoros,
Djibouti, Iraq, Mauritania, Somalia, the Sudan, Yemen and the
Syrian Arab Republic) and explain the significant gaps in average
life expectancy between countries.
Figure 4 shows significant gaps between countries. However, the
gap between the highest and the lowest life expectancy is expected to shrink significantly, from a
difference of 27.2 years in 1970 (the gap between Somalia, 40.9 years, and Qatar, 68.2 years) and of
23.5 years in 2015 (the gap between Somalia, 55.9 years, and Lebanon, 79.4 years) to about 18 years
in 2050 (Somalia, 66.8 years, and Lebanon, 85.2 years).
Women have longer life expectancy than men, which has increased from a difference of 2.6 years in
1970 to 3.9 years in 2015, and expected to reach 4 years by 2050. This difference in life expectancy
by sex translates into a higher number and proportion of older persons who are women than those
who are men, both at present and in the future. Since 2010, the greatest gender gap in life expectancy
has been in the Syrian Arab Republic (8.6 years) and it is likely to continue to be so through 2020
(8.9) because of the ongoing conflict, as it likely relates to trends in increasing numbers of premature
male deaths, mainly because of the civil war.
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
1970 1980 1990 2000 2010 2020 2030 2050
Figure 4A: Life Expectancy at (both sexes - in number of years) Birth in Arab countries with a fast rate of ageing:
1970-2050
Tunisia Lebanon
Algeria Morocco
All Arab countries
Life expectancy at
birth in the Arab
region has improved
by 10 hours per day,
on average, between
1970 and 2015.
15
Source: United Nations World Population Prospects (2017), Medium Variant. Note: (Life expectancy at birth for the whole Arab countries is computed using population weights)
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
1970 1980 1990 2000 2010 2020 2030 2050
Figure 4B: Life Expectancy at Birth (both sexes - in number of years) in Arab countries with a moderate rate of ageing:
1970-2050
Djibouti EgyptLibya JordanKuwait Syrian Arab RepublicAll Arab countries BahrainOman QatarSaudi Arabia United Arab Emirates
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
1970 1980 1990 2000 2010 2020 2030 2050
Figure 4C: Life Expectancy at Birth (both sexes - in number of years) in Arab countries with a slow rate of ageing): 1970-
2050
Comoros Somalia SudanMauritania Iraq State of PalestineYemen All Arab countries
16
b. Life expectancy at 60 years of age
Life expectancy at birth is influenced by high levels of infant mortality and
therefore tells us little about the survival of adults. Life expectancy at age
60 is a better estimate of survival within the adult life course,
particularly for low- and middle-income countries20. In the Arab
region, between 1970 and 2015, life expectancy at 60 years of age
grew substantially from 15.5 to 18.9 years, rising by 3.4 years or
almost 28 days annually (see annex table 5). In the future, according to
the World Population Prospects: The 2017 Revision, it will likely
attain 20 years in 2030 and 22 years in 2050. This gain in life
expectancy will be accompanied by a shift in the pattern of diseases and
causes of death. Life expectancy at 60 will be discussed in further detail in Chapter 2.
3. Human mobility
Human mobility can significantly impact population dynamics. For example, high numbers of
working-age immigrants can contribute to a slowing down of population decline and to the reduction
of population ageing. Countries in the Arab region have significantly different migration patterns,
with the GCC as one of the main destination sub-regions for international migrants, while, in contrast,
countries in the Mashreq have significant emigration due to ongoing conflict (Figure 5A). However,
given the high rates of return migration and negligible naturalization numbers, as well as the
predominant mobility of working-age persons, migration is not a significant source of ageing in the
region.
Immigration has played an important role in the demographic
growth in many Arab countries. For the CGC, immigrants
constitute an important fraction of the total population.
However, because of return migration –generally at advanced
ages- on one hand, and the fact that the age structure of
immigrants is generally significantly younger than that of the
national population, international migration is not a cause of
ageing in these countries.
From 1990 to 2013, there has been a substantial increase in international migration stocks in 12 out
of 17 Arab countries.21 During this period, migration stocks more than doubled in six out of the 17
Arab countries and more than tripled in three of them, namely Bahrain, Qatar and the United Arab
Emirates.
In some countries, the impact of migration on population growth may be temporary. During the last
decade, Lebanon and Jordan have had positive net migration, including forced migration, because of
conflicts in neighboring countries. However, these countries may later have negative net migration,
20 Help Age International. The Global Age Watch Index. http://www.helpage.org/global-agewatch/population-ageing-data/life-expectancy-at-60/
[accessed at 25/08/2017] 21
ESCWA. Arab society: a Compendium of social statistics. Issue No.12 (E/ESCWA/SD/2015/4; 1 December 2015)
Life expectancy at
60 years in the
Arab region has
improved at a rate
equivalent to
almost 28 days
annually between
1970 and 2015.
The number of
international migrants in
the Arab region nearly
doubled in 20 years but
may not have significant
impact on ageing.
17
due to the often-temporary nature of displacement and forced migration. In contrast, the Syrian Arab
Republic, which had experienced the highest negative net migration since 2000, is expected to
experience return net migration in the future. This pattern is similar to Iraq (net negative migration
from the year 2000 and net positive migration from 2010 to 2015). The state of Palestine, however,
seems to be marked by a regular negative and relatively slight net migration.
Since 2000, all Maghreb countries (except Mauritania) had negative net international migration.
According to UN projections, this pattern is predicted to continue in the future, but its scale will likely
decrease. This is also the case in Egypt, the Sudan, Yemen and, to a lesser extent, Somalia. On the
other hand, Comoros, Djibouti, and Mauritania have had small number of net migration and are likely
to witness no or slight net out-migration throughout the period covered by this study (Figure 5 B).
Source: Author's Calculations from the United Nations, World Population Prospects (2017), Medium Variant.
-3000.0
-2000.0
-1000.0
0.0
1000.0
2000.0
3000.0
1970 1980 1990 2000 2010 2015 2020 2030 2050
Figure 5A: Net International Migration in Mashreq and GCC countries:
1970 - 2050
Bahrain Iraq JordanKuwait Lebanon OmanQatar Saudi Arabia Syrian Arab RepublicUnited Arab Emirates Yemen All Arab countries
18
Source: Author's Calculations from United Nations, World Population Prospects (2017), Medium Variant.
-1500.0
-1000.0
-500.0
0.0
500.0
1000.0
1500.0
2000.0
2500.0
3000.0
1970 1980 1990 2000 2010 2015 2020 2030 2050
Figure 5B: Net International Migration in North Africa and the Arab
Least Developed Countries: 1970 - 2050
Comoros Djibouti Somalia Algeria
Egypt Libya Morocco Sudan
Tunisia Mauritania All Arab countries
19
C. Changing population age structure The previous discussion of population determinants in the Arab region has demonstrated that many
countries across the region have witnessed an age structure transition over the last three decades,
which is projected to continue over the course of the next thirty years. This trend of a decrease in the
demographic weight of children along with the increase in the demographic weight of the older
population leads to an ageing population in the region. Arab countries are at different stages of the
ageing process and are ageing at different paces, yet all of them are projected to age.
This section will examine the age structure transition as measured by the population age distribution
according to four broad age groups: children and young adolescents (aged 0-14 years); youth (aged
15-24 years); working-age persons (aged 25-59 years) and older persons (aged 60 years and above),
with a particular focus on older persons. The section then measures the pace of demographic transition
and examines the trend of dependency ratios.
1. Proportional age distribution
As has been noted by several researchers and institutions,22 the proportion of the age 0-14 group of
children and young adolescents is decreasing in all Arab countries (Table 2, Figure 8). This decline
was followed by a regression of the demographic weight of the youth group, aged 15-24. In contrast,
the proportions of the working-age population, 25-59 years of age, and of older persons, aged 60 and
above, are growing in all Arab countries, with no exceptions.
Age Group 1970 1980 1990 2000 2010 2020 2030 2040 2050
0-14 44.9 44,3 42,9 38,4 33,7 32,6 29,4 26,8 25,2
15-24 18.3 19,4 19,5 20,5 19,8 17,0 17,7 16,8 15,4
25-59 31.1 30,8 32,0 35,2 40,2 43,0 43,4 44,3 44,3
60 + 5,7 5,5 5,6 6,0 6,2 7,4 9,5 12,1 15,1
Table 1: Population in the Arab Region by Broad Age Groups: 1970 - 2050
Source: Author's calculations from the United Nations World Population Prospects (2017), medium variant.
22 See for example, ESCWA “Age-Structural Transitions and Sustainable Development in the Arab Region”
(E/ESCWA/SDD/2017/Pamphlet.1)
Saxena,P.C. (2009) Ageing and Age-Structural Transition in the Arab Countries: Estimated Period of
Demographic Dividends and Economic Opportunity. IUSSP http://iussp2009.princeton.edu/papers/91103
Zohry,A.(2013) Age-Structural Transition and the Arab Family. Paper presented at the International Seminar
Impact of Changing Population Dynamics on the Arab Family. Doha, 2-3 Dec. 2013
20
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant.
These changes vary from one country to another, (Table 3). From 1970 to 2015, in three countries
where fertility has declined most rapidly (see section on fertility), Lebanon, Tunisia and Morocco and
Algeria to a certain extent, the rise of the proportion of old persons has exceeded 4 per cent, while
the share of people aged less than 15 years has declined significantly by 18 to 22 per cent. This
demographic shift demonstrates why these countries have a “fast rate of ageing.” Libya has
experienced a similar trend, but not as significant as the three countries above. Egypt, with a generally
declining fertility rate but a slight increase in fertility recently, has experienced a similar change, but
less significantly. The latter two countries along with several others in the region are categorized as
having a moderate rate of ageing.
In the GCC, the proportion of older persons has slightly declined (except in Kuwait with a small
increase by 1.1 per cent) as well as that of the children group. Instead, the proportion of working-age
persons has increased significantly, including by 18 per cent in Saudi Arabia to 24 per cent in Oman
and Bahrain. This change is due mainly to an important net immigration to these countries combined
with a recent fertility decline. As a result, these countries are ageing at a slow rate.
0-14
15-24
25-59
60 +
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1970 1980 1990 2000 2010 2020 2030 2040 2050
Figure 6: Changes in the Population Age Composition in the Arab Region
21
0-15 15-59 60+ 0-15 15-59 60+ 0-15 15-59 60+ 0-15 15-59 60+
Algeria 46.9 47.4 5.7 28.7 62.4 8.9 24.7 62.1 13.3 19.9 57.1 23.0 100.0
Bahrain 44.8 51.1 4.1 20.8 75.0 4.1 16.7 74.1 9.2 13.5 69.2 17.4 100.0
Comoros 44.6 50.3 5.1 40.1 55.1 4.7 35.6 58.3 6.1 30.1 60.8 9.1 100.0
Djibouti 45.4 50.6 4.0 32.0 61.8 6.2 26.5 64.4 9.1 20.7 63.7 15.6 100.0
Egypt 42.0 51.4 6.6 33.1 59.2 7.7 29.5 60.7 9.9 25.4 59.1 15.4 100.0
Iraq 44.6 48.8 6.5 40.7 54.3 5.0 37.2 56.9 6.0 32.4 58.5 9.1 100.0
Jordan 46.0 49.1 4.9 36.0 58.4 5.5 29.8 61.5 8.7 23.9 60.8 15.4 100.0
Kuwait 44.1 53.0 3.0 20.9 75.0 4.1 19.1 68.9 12.1 17.1 62.4 20.5 100.0
Lebanon 41.9 50.6 7.5 24.0 64.5 11.5 18.9 62.1 19.0 13.8 55.0 31.2 100.0
Libya 46.2 48.9 4.8 28.6 64.9 6.5 22.5 66.5 11.0 18.2 59.1 22.8 100.0
Mauritania 46.0 49.7 4.3 40.2 54.8 4.9 36.6 57.2 6.2 31.7 59.5 8.8 100.0
Morocco 47.6 47.1 5.3 27.7 62.4 10.0 23.4 60.9 15.7 18.6 57.3 24.0 100.0
Oman 46.3 48.5 5.2 22.2 74.0 3.8 18.9 73.9 7.1 14.8 64.9 20.3 100.0
Qatar 36.1 60.7 3.2 13.8 83.8 2.3 13.2 78.2 8.6 11.4 70.4 18.2 100.0
Saudi Arabia 44.2 50.4 5.4 26.0 68.8 5.2 21.9 67.0 11.0 16.8 60.3 22.9 100.0
Somalia 43.3 51.4 5.3 46.7 49.0 4.3 44.2 51.4 4.5 38.1 56.6 5.3 100.0
State of Palestine 49.4 46.3 4.3 40.1 55.3 4.5 35.5 58.2 6.3 28.5 61.0 10.5 100.0
Sudan 46.3 48.9 4.8 41.5 53.1 5.4 36.7 56.8 6.5 31.5 60.2 8.3 100.0
Syrian Arabic Republic 48.1 46.9 5.1 38.1 55.5 6.4 28.1 62.5 9.3 21.9 62.0 16.1 100.0
Tunisia 45.5 48.8 5.7 23.7 64.6 11.7 21.4 60.9 17.7 17.8 55.7 26.5 100.0
U.A.E 35.1 62.6 2.3 13.8 84.3 2.0 12.1 79.8 8.1 12.0 69.3 18.7 100.0
Yemen 44.7 50.3 4.9 40.6 54.9 4.5 34.1 60.7 5.2 25.6 64.5 9.8 100.0
Arab Region 44.9 49.4 5.7 33.3 60.0 6.7 29.4 61.1 9.5 25.2 59.7 15.1 100.0
Source: United Nations World Population Prospects (2017), Medium Variant.
Table 2: Percent of the Population in Each Broad Age Group
Total
(Per
Year)
Country1970 2015 2030 2050
22
By 2030, the share of old persons will likely exceed 15 per cent in three countries: Lebanon (19.0
per cent), Tunisia (17.7 per cent) and Morocco (15.7 per cent). By 2050, these countries may have
more individuals aged 60 years and over than individuals aged less than 15 years. Algeria, Egypt,
Libya, Kuwait, Oman and Saudi Arabia are expected to have populations of over 60 years of age
comprising more than one fifth of their total population.
In contrast, in very youthful countries where fertility transition is not yet at advanced stage, the
older age group is expected to represent less than 10 per cent of the total population namely in
Comoros, Somalia, Iraq, Mauritania, Palestine, the Sudan and Yemen - the shape of the age
pyramid has not undergone any major transformation (see figure 7 in annex).
In terms of absolute numbers, however, the number of persons in each age group has increased
and will continue to do so in the future (table 4) even in youthful countries where the older persons
proportion of the total population will not dramatically increase, however their numbers will
increase. While decreasing as a share of the total population, the population of children less than
15 years of age has increased from 55.4 million in 1970 to 132.5 million in 2015 (with an annual
growth rate of 1.96 per cent), and the population of youth has increased from about 22.6 million
to 71.6 million with an annual growth rate of 0.72 per cent). These age groups are projected to
increase less rapidly: by 2050, the population of children is likely to attain 170 million and the
youth population is expected to grow to 104 million. Thus, overall, the demographic momentum
will compensate the effect of fertility decline. The estimated working-age population of 38.4
million in 1970 and 167.5 million in 2015 will continue to exert pressure on the labor market since
it is projected to increase to about 300 million in 2050, although its growth rate may see a
deceleration from 3.3 per cent during 1970-2015 to 1.7 per cent during 2015-2050. In contrast, the
population of older persons will not experience this trend, as it will likely continue to increase
rapidly with an unprecedented growth rate: 3 per cent during 1970-2015 and 3.9 per cent from
2015 to 2050. As a result, its number will rise to slightly more than 102 million.
Overall what these numbers indicate is that, in the past as in the future, the children age group
shows the lowest growth rate, followed by the adolescent age group, while the age group of older
persons displays the highest growth rate, followed by the working-age group. This implies that
even in medium and slow ageing countries, the proportion of older persons may not increase
dramatically, but there numbers will, and thus should have an impact policymaking.
\7
Year 0-14 15-24 25-59 60+ Total
1970 55413 22575 38440 7095 123523
2015 132562 71598 167560 26826 398546
2030 153179 92023 225980 49594 520776
2050 170404 104144 299715 102087 676350
Table 3: Population in the Arab Region (in thousands) by Broad Age Groups 1970-2050
Source: Author's Calculatios from the United Nations World Population Prospects (2017), Medium Variant.
23
Furthermore, because of the relatively large number of net international migration in some
countries as discussed earlier in the chapter (figures 5A and 5B above, and table 6 in annex), their
older population has experienced unprecedented demographic growth from 1970 to 2015. In the
UAE, it multiplied by about 33 and in Qatar, by almost 17. The working-age population in these
countries has also experienced significant growth, multiplying by slightly more than 52 and 31,
respectively, during the same period. The growth of the working age population relative to growth
of the older population explains why, in relative terms, their populations were not ageing during
this period. For similar reasons, the older populations of other countries also experienced rapid
growth, even though their share of the total population in 2015 was still low (ranging between 4.1
per cent to 5.5 per cent), including Kuwait, Bahrain, Saudi Arabia, Jordan, Djibouti and Oman.
This rate of growth is shown by table 5A, which gives the annual growth rates for different past
periods.
Country 1970-2015 1970-1980 1980-1990 1990-2000 2000-2010 2010-2015
Algeria 3.2 2.1 2.8 3.9 3.5 4.7
Bahrain 4.2 4.3 3.2 3.2 5.5 5.0
Comoros 2.5 3.1 2.3 2.3 1.9 3.3
Djibouti 4.9 7.7 5.7 3.2 3.6 3.0
Egypt 2.5 2.6 2.9 2.2 2.3 2.6
Iraq 2.3 2.6 1.4 2.3 1.8 4.3
Jordan 4.0 2.8 4.2 3.9 4.4 5.2
Kuwait 4.4 4.5 3.0 2.6 5.2 8.9
Lebanon 3.0 1.0 2.7 3.0 4.3 5.3
Libya 3.0 3.4 4.2 3.3 1.8 1.8
Mauritania 3.2 3.8 3.3 2.8 2.7 3.4
Morocco 3.1 1.9 4.6 3.1 2.3 4.3
Oman 3.2 2.6 2.7 3.4 2.7 6.2
Qatar 6.2 5.2 6.1 4.8 6.2 11.6
Saudi Arabia 3.7 3.7 4.3 2.7 2.9 5.9
Somalia 2.7 5.9 0.5 1.1 2.9 3.1
State of Palestine 3.3 0.8 3.0 5.2 3.8 3.6
Sudan 3.2 3.1 3.2 3.4 3.0 3.4
Syrian Arab Republic 2.9 2.4 3.6 2.9 3.1 2.1
Tunisia 3.4 2.8 4.7 4.2 1.7 3.5
United Arab Emirates 7.7 13.2 5.6 4.1 8.6 6.8
Yemen 3.1 1.8 2.5 5.0 2.9 3.2
All Arab countries 3.0 2.6 3.2 2.9 2.8 3.5
Table 4A: Annual Growth Rate (in %) of Population (Both Sexes) 60 Years and Older (1970 - 2015)
Source: Author's calculatios from the United Nations World Population Prospects (2017), medium variant.
In the future, from 2015 to 2050, countries that will likely experience the highest growth in the
population of older persons, in order of growth rate, are: UAE, Qatar, Oman, Kuwait, Bahrain and
Saudi Arabia. In contrast, the population of older persons in Lebanon, Tunisia, and Morocco are
expected to grow relatively less rapidly, but still enough that they will likely grow by rates of
respectively ranging from 2.6 to 3.3 per cent annually. The early decline of their fertility levels
24
probably explains this trend. In countries like Somalia and Sudan, the population of older persons
will likely grow less rapidly, mainly due to high mortality levels.
Country 2015-2050 2015-2020 2020-2030 2030-2040 2040-2050
Algeria 3.7 2.5 3.9 3.8 3.4
Bahrain 5.6 9.0 7.1 5.3 2.5
Comoros 3.7 2.9 3.7 3.5 3.7
Djibouti 3.6 2.7 3.9 3.5 3.3
Egypt 3.4 2.1 3.3 3.5 3.5
Iraq 4.0 1.4 4.3 4.8 3.8
Jordan 4.2 2.5 4.5 4.6 3.5
Kuwait 5.7 9.8 8.0 5.0 1.8
Lebanon 2.6 1.3 2.6 2.2 2.8
Libya 4.4 1.7 5.4 5.4 2.9
Mauritania 3.8 3.0 4.1 3.9 3.4
Morocco 3.3 3.4 3.8 2.8 2.5
Oman 6.1 4.9 6.6 6.4 5.4
Qatar 7.1 10.7 10.1 5.5 3.6
SaudiArabia 5.2 5.0 6.8 5.6 3.0
Somalia 3.3 2.2 3.1 3.1 3.6
State of Palestine 4.5 2.7 5.0 4.5 4.3
Sudan 3.3 2.4 3.6 3.3 3.1
SyrianArabRepublic 4.3 2.4 5.5 4.2 3.7
Tunisia 2.9 2.3 3.6 2.5 2.3
United ArabEmirates 7.5 11.2 10.5 6.7 3.4
Yemen 3.9 2.2 3.0 4.0 5.1
All Arab countries 3.8 2.7 4.2 4.0 3.3
Table 4B: Prospective Annual Growth Rate (in%) of Population (Both Sexes) 60 Years and Older (2015-
2050)
Source: Author's calculatios from the United Nations World Population Prospects (2017), Medium Variant.
2. Age and Sex distribution of older persons
The population of older persons in different countries is not homogeneous in many respects. Their
multiple demographic and socioeconomic characteristics mean that the risks to which they are
exposed and their vulnerabilities vary widely. Age and sex are among these characteristics.
Available data indicate a female predominance in the older population in 16 out of 22 Arab
countries in 2015 (see figure 8 below and table 8 in annex). Primarily in the GCC countries,
however, males outnumber females as a result of net immigration. In fact, in 2015, the ratio of men
to women at older ages range from less than 76 in Mauritania to over 257 in UAE. In 2030, this
ratio is expected to range from 79 in Iraq to 340 in Qatar.
25
Source: Author’s calculations from the United Nations World Population Prospects (2017), Medium Variant
3. The age distribution transition
As indicated before, the population of older persons aged 60 years and above in the whole Arab
region has more than quadrupled since 1970, increasing from approximately 7 million in 1970 to
27 million in 2015. Despite this increase, this age group still currently constitutes the smallest
proportion of the Arab population, moving up from 5.4 per cent to 6.7 per cent over the mentioned
period. Of the older persons age group, only 4.3 per cent of people are more than 65 years old and
only 1.5 per cent are aged 75 years or older (Table 8). In other words, the population of older
persons in the Arab region is still young compared to that of OECD countries. The share of OECD
population 65 years and above varies by country from 15 per cent to 23 per cent in 2010.23 This
conclusion also remains true when we compare individual Arab countries. Only Tunisia and
Lebanon have relatively significant proportions of the population 65 years or older (7.6 per cent
23 https://fr.statista.com/statistiques/562594/part-de-la-population-agee-de-plus-de-65-ans-ocde/ [accessed on
3/09/2017]
Bahrain
Kuwait
104Lebanon
Oman
Qatar
214
Saudi Arabia
124
UAE
70
120
170
220
270
320
1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
exe
rat
io (
%)
Figure 7: Sex Ratio (M/F) of Poeple 60 Years and Older , 1970 to 2050Comoros Djibouti
Somalia Algeria
Egypt Libya
Morocco Sudan
Tunisia Mauritania
Bahrain Iraq
Jordan Kuwait
Lebanon Oman
Qatar Saudi Arabia
State of Palestine Syrian Arab Republic
United Arab Emirates Yemen
Arab country Line 100%
26
and 8.1 per cent, respectively) while shares of the total population of 75 years or older are small
(3.1 per cent and 3.2 per cent respectively). However, we should note that even if these proportions
are relatively not so high in absolute numbers, the corresponding population is increasing rapidly,
which highlights the serious nature of the ageing phenomenon, its consequences for societies and
implications in terms of policies and preparation.
60+ 65+ 75+
Algeria 8.9 5.9 2.3
Bahrain 4.1 2.3 0.7
Comoros 4.7 2.9 0.9
Djibouti 6.2 4.1 1.2
Egypt 7.7 5.1 1.6
Iraq 5.0 3.1 1.0
Jordan 5.5 3.8 1.3
Kuwait 4.1 2.1 0.5
Lebanon 11.5 8.1 3.2
Libya 6.5 4.3 1.6
Mauritania 4.9 3.1 0.9
Morocco 10.0 6.4 2.4
Oman 3.8 2.3 0.8
Qatar 2.3 1.1 0.3
Saudi Arabia 5.2 3.1 1.0
Somalia 4.3 2.7 0.7
State of Palestine 4.5 3.0 0.9
Sudan 5.4 3.5 1.1
Syrian Arab Republic 6.4 4.0 1.5
Tunisia 11.7 7.6 3.1
United Arab Emirates 2.0 1.0 0.2
Yemen 4.5 2.9 0.8
All Arab countries 6.7 4.3 1.5
Country
% of the Total Population
Table 5: Proportion (%) of the Population 60, 65 and 75 Years and Older (2015)
Source: The United Nations World Population Prospects (2017)
Because the rapid growth rate of these population categories and the sharp decline of their fertility,
three Arab countries, namely Lebanon, Morocco and Tunisia, will be ageing in 2030. A country is
considered to be ageing “when the proportion of its population aged 65 and above surpasses 8-10 per cent”
(Gavrilov and Heuveline, 2003.”)2425 The populations of Tunisia and Lebanon will be ageing even
earlier, as their populations aged 65 years and older is expected to attain a proportion of 8.8 per
24 Gavrilov, L.A., P. Heuveline (2003). Ageing of population. In Paul Demeny and Geoffrey McNicoll, eds., The
Encyclopedia of Population. New York, Macmillan Reference. (Cited in ESCWA (2017). Age-Structural Transitions and…) 25 ESCWA (2017). Age-Structural Transitions and Sustainable Development in the Arab Region.
E/ESCWA/SDD/2017/Pamphlet.1https://www.unescwa.org/sites/www.unescwa.org/files/publications/files/age-structural-transitions-arab-region-
english.pdf [acceded on 01/09/2017]
27
cent and 9.2 per cent, respectively, in 2020. Considering the population aged 75 years and older
as the category the most vulnerable to have high levels of dependency, data and projections show
that it will not likely equal or exceed 8 per cent by 2050 (table 8), except in these three Arab
countries.
Country 2015 2030 2050
Algeria 2.3 3.5 7.1
Bahrain 0.7 1.2 5.4
Comoros 0.9 1.0 1.6
Djibouti 1.2 1.7 3.3
Egypt 1.6 2.1 3.7
Iraq 1.0 1.2 2.0
Jordan 1.3 1.6 4.2
Kuwait 0.5 1.3 6.3
Lebanon 3.2 5.6 11.1
Libya 1.6 2.0 6.1
Mauritania 0.9 1.0 1.6
Morocco 2.4 3.7 8.0
Oman 0.8 1.3 5.1
Qatar 0.3 0.9 5.7
Saudi Arabia 1.0 1.7 6.4
Somalia 0.7 0.8 1.0
State of Palestine 0.9 1.2 2.5
Sudan 1.1 1.3 1.8
Syrian Arab Republic 1.5 2.1 4.4
Tunisia 3.1 4.3 8.8
United Arab Emirates 0.2 0.7 5.8
Yemen 0.8 1.0 1.5
Arab Region 1.5 2 4
Table 6: Proportion of the Population 75 Years and Older
Source: The United Nations World Population Prospects (2017)
The pace of age distribution transition
While demographic transition and population ageing in developed countries has occurred over
long stretches of times, this is not the case in Arab countries. In nearly half of Arab countries, the
ageing process is taking place at a fast or moderate pace, driven primarily by a rapid fertility
decline but increasingly, also, by a steady increase in life expectancy. Therefore, the Arab region’s
countries will likely have little time to adjust to the consequences of population ageing, especially
considering that the level of social and economic development in many countries of the region is
still relatively low.
Figure 11 shows two important trends about population ageing in the Arab region. First, the figure
shows the estimated length of time that over which population ageing will occur. This is shown by
indicating the years in which the population will transition from an ageing population (older
28
persons aged 60 and over constitute 7 percent of the total population) to an aged population (older
persons aged 60 and over constitute 14 percent of the total population. On average, the transition
period in which population ageing will occur will take periods of time ranging from 13 to 40 years.
This transition is much more fast-paced compared to the length of time that it took for OECD
countries to age, which was 50 to 150 years in most OECD countries.
Second, this figure also predicts the dates at which each population will experience the transition
from “ageing” to “aged.” These dates are especially important for policymakers to consider, noting
that the time preceding the date of ageing is valuable time for planning appropriate policies in
anticipation and response to the specific needs of older persons. As the figure indicates, with the
exception of countries with a “fast rate of ageing” from 1970 to 2015 (Lebanon, Tunisia, Morocco
and Algeria), the majority of Arab countries are just in the beginning of this process. Very soon,
other countries will also experience rapid ageing. Countries that experienced “moderate rate of
ageing” between 1970 and 2015 - namely Djibouti, Egypt, Libya, Jordan, Kuwait and Syria – are
predicted to begin the ageing transition between 2030 and 2040 and become aged populations by
as early as 2047 for Libya and as late as 2078 for Algeria. Other countries witnessed a “slow rate
of ageing” in the period 1970-2015 (such as GCC countries, the State of Palestine and Yemen).
Mauritania, Sudan, Somalia, Iraq and Comoros are countries where the ageing process is expected
to take longer than in other Arab countries and to continue beyond 2100.
29
Source: Author calculation according to data of United Nations (World Population Prospects, 2017), medium variant
Note: Figure shows starting and ending year for transition from an ageing population (older persons aged 65 and over constitute 7 percent of the total population) to an aged population (older persons aged 60 and over constitute 14 percent of the total population).
30
A. Dependency Ratios
In order to evaluate the economic impact of ageing on society's resources, demographers use
measure known as the dependency ratio. This ratio is calculated as the number of people in a
“dependent age group” (people younger than 15 or older than 64 years) divided by “the working-
age population” (people aged 15-64). 26
Adding the child and old-age dependency ratios together
results in the total dependency ratio. Often, it is assumed that
older persons and children are dependent on caregivers or
persons of working-age in the same way. However, older
persons and children are not dependent in the same way or to
the same degree. For example, many older persons are
physically dependent, but are financially independent, while
children are, in general, dependent financially and physically.
In addition, researchers argue that dependency ratios have
critical limitations since they conflate age with dependency, both for populations aged 65 years
and above and for those under age 15. Dependency ratios are presented in this section to serve as
an indicator and measure of ageing, but, given these limitations, should be interpreted with caution.
Figure 12 illustrates the past trends in the child, old-age and total dependency ratios for the Arab
region from 1970 to 2015 and the projected trends for these ratios through 2050. The results show
that the child dependency ratio decreased from 87.1 per cent in 1970 to 53.3 per cent in 2015, after
which a steady decline will continue in the future. At the same time, the old age dependency ratio,
which stood around 7 per cent between 1970 and 2015, will start an upward trend through 2050,
when it is expected to attain 16.6 per cent. Consequently, the total dependency ratio decreased
rapidly between 1970 and 2015, from 94.2 per cent to 60.2 per cent. In the future, the rate of
decline will reduce such that the total dependency ratio will stay above 55 per cent through 2050.
26 Dividing old dependency ratio by child dependency ratio, we obtain an index of ageing.
Changing trends in population shares of the population of older persons compared to persons of
working-age shows that the dependency ratio in the Arab
region is shifting gradually toward more dependency of
older persons.
31
Source: United Nations, World Population Prospects (2017), Medium Variant.
According to available data for 2015, countries in the region with high fertility also had relatively
high dependency ratios. These countries included Somalia, Sudan, Iraq, Yemen, Mauritania, the
State of Palestine and Comoros. In contrast, countries with high net immigration, primarily through
labour migration, had small total dependency ratios. These countries were UAE, Qatar, Kuwait,
Bahrain and Oman (see Annex 10).
94.5 92.387.5
74.7
62.7 62.0 61.356.6 54.5 56.2
87.4 85.580.8
67.8
56.0 55.1 53.646.9
42.0 39.6
7.1 6.9 6.7 7.0 6.7 7.0 7.7 9.7 12.516.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
Figure 9: Dependency Ratios (%) in the Arab Region, 1970 to 2050
Total Dependency Ratio Child Dependency Ratio Old Dependency Ratio
94.5 92.387.5
74.7
62.7 62.0 61.356.6 54.5 56.2
87.4 85.580.8
67.8
56.0 55.1 53.646.9
42.0 39.6
7.1 6.9 6.7 7.0 6.7 7.0 7.7 9.7 12.516.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
Figure 10: Dependency Ratios (%) in the Arab Region, 1970 to 2050
Total Dependency Ratio Child Dependency Ratio Old Dependency Ratio
32
Owing to their early fertility transition, Lebanon, Tunisia and, to some extent, Morocco were the
three countries with relatively significant old-age dependency ratios: 12 per cent, 11 per cent and
9.7 per cent in 2015, respectively. Algeria will likely have an equivalent level by 2020. Fifteen
years later, these countries will be likely marked by important levels of such ratios, varying from
14 per cent in Algeria to 20.6 per cent in Lebanon. In 2050, all Arab countries are expected to have
relatively high total dependency ratios, except those with currently high fertility: Somalia, Sudan,
Mauritania, Comoros, Yemen, State of Palestine and Iraq (Table 10 below).
Country 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
Algeria 7.1 6.8 6.3 7.1 8.1 9.0 10.8 14.0 18.5 26.9
Bahrain 4.7 3.3 3.4 3.6 2.7 3.0 3.4 7.3 12.7 17.8
Comoros 5.8 6.2 6.2 5.7 5.3 5.1 5.4 6.3 7.3 9.0
Djibouti 4.6 4.6 4.9 5.4 5.9 6.4 6.7 8.7 11.1 14.6
Egypt 7.9 8.1 8.3 8.4 7.6 8.2 8.7 10.3 12.4 16.5
Iraq 7.8 8.3 7.6 6.5 6.0 5.5 5.9 6.0 8.1 10.0
Jordan 6.4 6.7 6.3 5.3 6.2 6.2 6.4 8.3 12.5 16.9
Kuwait 3.4 2.8 2.1 2.2 2.7 2.7 4.0 9.0 17.9 23.3
Lebanon 9.5 9.7 9.9 11.1 12.4 12.0 13.3 20.6 27.1 37.1
Libya 6.0 5.6 5.6 6.0 6.2 6.4 6.8 9.1 16.5 25.5
Mauritania 4.8 5.5 6.0 5.9 5.6 5.5 5.6 6.5 7.7 9.1
Morocco 7.0 6.2 7.0 8.6 9.4 9.7 11.6 17.2 21.9 28.5
Oman 6.3 5.2 4.4 4.0 3.8 3.1 3.3 5.8 10.6 19.3
Qatar 3.2 2.4 1.8 2.3 1.2 1.3 2.1 5.6 12.0 16.6
Saudi Arabia 6.6 5.6 5.1 5.1 4.4 4.3 5.2 9.2 16.6 25.1
Somalia 5.9 6.0 5.6 5.3 5.3 5.3 5.4 5.4 5.4 5.6
State of Palestine 6.0 4.7 4.3 4.6 5.0 5.2 5.4 6.6 8.5 10.9
Sudan 5.9 5.9 5.7 5.8 6.1 6.3 6.5 7.1 7.9 8.8
Syria 6.9 6.2 6.1 6.0 5.8 7.0 8.0 9.6 12.5 17.4
Tunisia 6.8 7.2 8.4 10.6 10.8 11.1 13.2 18.8 24.1 31.7
UAE 2.3 2.0 1.8 1.5 0.9 1.2 1.6 5.3 12.2 18.5
Yemen 5.8 5.9 5.4 5.8 4.9 5.1 5.2 5.4 6.0 8.7
Arab Region 7.1 6.9 6.7 7.0 6.7 7.0 7.7 9.7 12.5 16.5
Table 7: Old Age Dependency Ratio (%)
Source: The United Nations World Population Prospects (2017)
2) De facto population as of 1 July of the year indicated.
Notes: 1) Old-Age Dependency Ratio (Age 65+ / Age 15-64)
The observed and expected rise in the old-age dependency ratios is generally offset by the rapid
decline of child dependency ratios. Child dependency ratios decreased from 1970 to 2015, except
in Somalia where it increased before it started to decline after 2000. Decline is expected to be the
most significant in Bahrain, Oman, Syria, Algeria, Libya, Morocco and Tunisia (Annex 13).
B. Key findings and conclusions
As demonstrated by the demographic trends and prospects discussed in this chapter, the Arab
region is rapidly progressing toward a period of population ageing as a result of high levels of
fertility in all Arab countries prior to the 1970’s, alongside increased life expectancy at birth and
at 60 years of age.
33
The total population of Arab countries has more than tripled, growing from 123.5 million in 1970
to 398.5 million in 2015 and is expected to grow further to about 520.8 million by 2030 and to
676.3 million by 2050. This growth will occur more slowly, at an average annual growth rate of
1.52 per cent between 2015 and 2050.
During 1980-2010, fertility has been steadily declining in all Arab countries at varied rates, except
in Somalia. It is expected that most Arab countries will reach below replacement levels of fertility
by 2050, with Somalia and Mauritania as exceptions, with total fertility rates above 3, and
Comoros, Sudan, Iraq, the State of Palestine and Egypt with fertility rates between 2.3 and 3
children per woman.
While in 1970, life expectancy at birth was estimated at below 60 years of age in 16 Arab countries,
in 2015, life expectancy at birth is equal to or exceeds 70 years of age. By 2050, life expectancy
at birth for all Arab countries is predicted to attain an average of 76.4 years, ranging from 66.8
years in Somalia to 85.2 in Lebanon. Life expectancy at age 60 is a better estimate of survival
within the adult lifecourse. In the Arab region, life expectancy at age 60 increased by 3.4 years
from 15.5 to 18.9 years between 1970 and 2015. In the future, it will likely reach 20 years in 2030
and 22 years in 2050. Women will continue to outlive men as their average life expectancy will be
higher by four years compared to men. As a result, it is likely to have a higher number of older
persons who are women than men, today and in the future.
The third component of the demographic dynamics is migration, which has played an important
role in the demographic growth in many Arab countries. For the GCC countries, immigrants
constitute an important fraction of the total population. However, because return migration often
occurs at advanced ages and the age structure of immigrants is usually significantly younger than
the national population, international migration is not believed to be a major source of ageing in
these countries. Rather, it is a factor that may postpone the ageing process.
This predicted decline of fertility combined with a general decrease in mortality will have a major
impact on the age structure of populations, in particular on the number of older persons. The data
analysis in this chapter indicates that ageing is a phenomenon the will occur in Arab countries,
although at different times and different rates in each country according to varying stages of
demographic transition.
The findings of this chapter revealed several important features of ageing in the region. First,
population ageing in the Arab region is occurring at the same time as the generation of the youth
“bulge” age enter into working age. These two demographic phenomena of large ageing
populations and of youth progressing to working age exerts pressure on the countries that must
devote resources to address the needs of both groups simultaneously.
Second, population ageing in most Arab countries is already occurring or will occur in the coming
years at a much faster pace than that experienced by other regions such as the OECD countries,
due to the rapid speed of the decline in fertility during the last four decades. This rapid transition
means that countries have a short time frame to adapt to the needs of a changing age structure.
34
Third, the predominance of women among older persons indicates the need for additional
resources. This is the result of being among the most vulnerable to poverty since they are the least
educated, least employed, have less resources or lesser pension plans from past work and it’s the
category that is most affected by chronic diseases.
Finally, this rapid transition is coupled with slowly changing family structures. Family members
have been the principal providers of older persons care in the Arab countries in light of weak social
protection systems. Therefore, decrease in the number of children, family nuclearization,
urbanization and intensification of migratory movements will have serious impacts on the care
provided for older persons.
In light of these findings, there is an urgent need for immediate intervention on all Arab countries
to address the implications of the age structure transition to ensure that older persons today and in
the future, can age in dignity. This chapter begins to build the case for evidence-based response to
this unique demographic phenomenon in the Arab region and the specific implications for each
country. The following chapters build on these findings to: delve deeper into the socio-economic
conditions of older persons in the region today and effect the intergenerational support on older
persons; project situation of older persons in the future; and accordingly propose a set of policy
recommendations that can guide countries depending on the rate and stage of ageing.
35
Annexes
Region, Subregion or Country 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
World 3700578 4458412 5330943 6145007 6958169 7383009 7795482 8551199 9210337 9771823
More Developed Regions 1009082 1084244 1146999 1190505 1235143 1253207 1269277 1289937 1297496 1298069
Less Developed Regions 2691496 3374167 4183944 4954502 5723027 6129802 6526205 7261262 7912841 8473754
Least Developed Regions 308486 393279 510828 664805 848792 956631 1073984 1334196 1618985 1916742
High-Income Countries 851319 929939 1000109 1070130 1148592 1180061 1207775 1249896 1275679 1287798
Middle-Income Countries 2652001 3275988 4006282 4647490 5246882 5558264 5852576 6362054 6764840 7067079
Low-Income Countries 195911 250969 322686 425130 560007 641859 732133 935905 1166159 1413034
Algeria 14550 19338 25912 31184 36118 39872 43333 48822 53249 57437
Bahrain 213 360 496 665 1241 1372 1698 2013 2205 2327
Comoros 230 308 412 542 690 777 870 1062 1262 1463
Djibouti 160 359 590 718 851 927 1000 1133 1237 1308
Egypt 35046 44099 57412 69906 84108 93778 102941 119746 137066 153433
Iraq 9918 13653 17469 23565 30763 36116 41503 53298 66752 81490
Jordan 1719 2374 3561 5103 7182 9159 10209 11122 12680 14188
Kuwait 747 1372 2100 2051 2998 3936 4303 4874 5324 5644
Lebanon 2297 2605 2703 3235 4337 5851 6020 5369 5392 5412
Libya 2134 3219 4437 5356 6169 6235 6662 7342 7825 8124
Mauritania 1149 1534 2030 2709 3610 4182 4784 6077 7482 8965
Morocco 16000 20020 24879 28850 32410 34803 37071 40874 43714 45660
Oman 724 1154 1812 2268 3041 4200 5150 5897 6344 6757
Qatar 110 224 476 592 1780 2482 2792 3232 3537 3773
Saudi Arabia 5836 9741 16327 20764 27426 31557 34710 39480 42778 45056
Somalia 3445 6359 7397 9011 12053 13908 16105 21535 28146 35852
State of Palestine 1125 1509 2101 3223 4067 4663 5323 6739 8208 9704
Sudan 10282 14507 20148 27251 34386 38648 43541 54842 67357 80386
Syria 6351 8931 12446 16411 21019 18735 18924 26608 30799 34021
Tunisia 5060 6368 8233 9699 10640 11274 11903 12842 13435 13884
UAE 235 1042 1860 3155 8271 9154 9813 11055 12207 13164
Yemen 6194 8120 12057 17875 23607 26916 30245 36815 42986 48304
Arab Region 123525 167196 224858 284133 356767 398545 438900 520777 599985 676352
Arab Region/Word (%) 3.3 3.8 4.2 4.6 5.1 5.4 5.6 6.1 6.5 6.9
Source: United Nations World Population Prospects (2017), Medium Variant.
Annex 1: Population in Thousands
36
Region, subregion or Country 1970-1980 1980-1990 1990-2000 2000-2010 2010-2015 2015-2020 2020-2030 2030-2040 2040-2050
World 1.88 1.80 1.43 1.25 1.19 1.09 0.93 0.75 0.59
More Developed Regions 0.72 0.56 0.37 0.37 0.29 0.26 0.16 0.06 0.00
Less Developed Regions 2.29 2.17 1.70 1.45 1.38 1.26 1.07 0.86 0.69
Least Developed Regions 2.46 2.65 2.67 2.47 2.42 2.34 2.19 1.95 1.70
High-Income Countries 0.89 0.73 0.68 0.71 0.54 0.47 0.34 0.20 0.09
Middle-Income Countries 2.14 2.03 1.50 1.22 1.16 1.04 0.84 0.62 0.44
Low-Income Countries 2.51 2.55 2.80 2.79 2.77 2.67 2.49 2.22 1.94
Algeria 2.89 2.97 1.87 1.48 2.00 1.68 1.20 0.87 0.76
Bahrain 5.40 3.26 2.97 6.44 2.03 4.36 1.72 0.92 0.54
Comoros 2.96 2.95 2.80 2.43 2.42 2.27 2.02 1.74 1.49
Djibouti 8.44 5.10 1.97 1.72 1.73 1.52 1.25 0.88 0.56
Egypt 2.32 2.67 1.99 1.87 2.20 1.88 1.52 1.36 1.13
Iraq 3.25 2.50 3.04 2.70 3.26 2.82 2.53 2.28 2.02
Jordan 3.28 4.13 3.66 3.48 4.98 2.19 0.86 1.32 1.13
Kuwait 6.27 4.34 -0.24 3.87 5.59 1.80 1.25 0.89 0.58
Lebanon 1.27 0.37 1.81 2.97 6.17 0.57 -1.14 0.04 0.04
Libya 4.20 3.26 1.90 1.42 0.21 1.33 0.98 0.64 0.37
Mauritania 2.93 2.84 2.93 2.91 2.99 2.72 2.42 2.10 1.82
Morocco 2.27 2.20 1.49 1.17 1.44 1.27 0.98 0.67 0.44
Oman 4.78 4.61 2.27 2.98 6.67 4.16 1.37 0.73 0.63
Qatar 7.41 7.85 2.20 11.63 6.87 2.38 1.47 0.91 0.65
Saudi Arabia 5.26 5.30 2.43 2.82 2.85 1.92 1.30 0.81 0.52
Somalia 6.32 1.52 1.99 2.95 2.90 2.98 2.95 2.71 2.45
State of Palestine 2.98 3.36 4.37 2.35 2.77 2.68 2.39 1.99 1.69
Sudan 3.50 3.34 3.07 2.35 2.36 2.41 2.33 2.08 1.78
Syrian Arab Republic 3.47 3.37 2.80 2.51 -2.27 0.20 3.47 1.47 1.00
Tunisia 2.33 2.60 1.65 0.93 1.16 1.09 0.76 0.45 0.33
United Arab Emirates 16.04 5.96 5.42 10.12 2.05 1.40 1.20 1.00 0.76
Yemen 2.75 4.03 4.02 2.82 2.66 2.36 1.99 1.56 1.17
Arab Region 3.07 3.01 2.37 2.30 2.24 1.95 1.73 1.43 1.21
Annex 2: Annual Growth Rate (%)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
37
Region, Subregion or Country 1970 1980 1990 2000 2010 2015 2020 2030 2050
World 4.7 3.7 3.2 2.7 2.5 2.5 2.5 2.4 2.2
More Developed Regions 2.3 1.9 1.7 1.6 1.7 1.7 1.7 1.8 1.8
Less Developed Regions 5.7 4.4 3.6 2.9 2.7 2.6 2.6 2.4 2.3
Least Developed Regions 6.8 6.6 6.0 5.2 4.5 4.2 3.9 3.4 2.9
High-Income Countries 2.5 2.0 1.8 1.7 1.7 1.7 1.7 1.8 1.8
Middle-Income Countries 5.3 4.1 3.4 2.6 2.4 2.4 2.3 2.2 2.1
Low-Income Countries 6.6 6.6 6.3 5.9 5.2 4.8 4.4 3.8 3.0
Algeria 7.6 6.7 4.7 2.6 2.8 2.8 2.5 2.2 2.0
Bahrain 6.5 4.9 3.7 2.8 2.2 2.1 1.9 1.8 1.7
Comoros 7.1 7.1 6.4 5.4 4.8 4.4 4.1 3.5 2.8
Djibouti 6.8 6.5 6.0 4.5 3.3 2.9 2.6 2.3 1.9
Egypt 6.2 5.6 4.6 3.3 3.2 3.3 3.1 2.7 2.3
Iraq 7.3 6.6 5.9 4.9 4.6 4.4 4.1 3.7 3.0
Jordan 7.9 7.2 5.5 4.1 3.7 3.4 3.1 2.7 2.2
Kuwait 7.1 5.3 3.1 2.8 2.2 2.0 1.9 1.9 1.8
Lebanon 4.9 4.0 3.0 2.2 1.6 1.7 1.7 1.7 1.7
Libya 8.0 7.2 5.0 2.9 2.4 2.3 2.1 1.9 1.8
Mauritania 6.8 6.5 6.0 5.5 5.0 4.7 4.4 3.9 3.2
Morocco 6.6 5.7 4.1 2.8 2.6 2.5 2.4 2.1 1.9
Oman 7.4 8.2 7.1 3.8 2.9 2.7 2.4 2.0 1.7
Qatar 6.9 5.8 4.1 3.2 2.1 1.9 1.8 1.7 1.6
Saudi Arabia 7.3 7.1 5.9 4.0 3.0 2.6 2.4 2.1 1.8
Somalia 7.2 7.0 7.4 7.6 6.9 6.4 5.9 5.0 3.7
State of Palestine 7.8 7.3 6.7 5.4 4.4 4.1 3.8 3.2 2.6
Sudan 6.9 6.8 6.2 5.5 4.9 4.6 4.3 3.8 3.0
Syrian Arab Republic 7.6 7.0 5.3 4.1 3.2 3.0 2.7 2.4 1.9
Tunisia 6.7 5.2 3.5 2.2 2.1 2.2 2.1 2.0 1.9
United Arab Emirates 6.6 5.5 4.4 2.7 1.9 1.8 1.7 1.6 1.6
Yemen 7.9 8.7 8.5 6.4 4.7 4.1 3.6 2.9 2.1
Arab Region 6.9 6.3 5.2 3.9 3.5 3.4 3.2 2.8 2.4
Annex 3: Total Fertility (Children per Women)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
38
Region, Subregion or Country 1960 1970 1980 1990 2000 2010 2015 2020 2030 2050
World 50.3 56.8 61.2 64.1 66.4 69.9 71.4 72.4 74.3 77.3
More Developed Regions 68.6 70.7 72.4 74.1 75.2 77.7 78.9 79.7 81.3 84.2
Less Developed Regions 45.1 53.2 58.5 61.9 64.6 68.2 69.7 70.9 72.8 76.1
Least Developed Regions 39.8 43.8 47.3 51.1 55.1 61.2 63.6 65.3 68.1 72.6
High-Income Countries 68.0 70.4 73.1 75.4 77.7 79.9 80.8 81.6 83.1 85.7
Middle-Income Countries 46.9 54.9 60.0 63.3 65.8 69.1 70.5 71.6 73.5 76.7
Low-Income Countries 38.5 42.8 46.6 49.1 52.1 58.9 61.7 63.7 66.9 71.6
Algeria 46.1 50.5 58.3 66.5 70.3 74.6 75.8 76.9 78.9 82.3
Bahrain 51.9 63.2 69.4 72.4 74.4 76.0 76.8 77.4 78.8 81.4
Comoros 41.5 45.7 50.7 56.6 59.4 61.9 63.4 64.5 66.3 69.1
Djibouti 44.1 49.1 53.6 56.6 57.2 60.3 62.1 63.2 65.0 68.0
Egypt 47.8 52.3 58.3 64.5 68.5 70.4 71.3 72.2 73.8 76.7
Iraq 47.9 57.9 60.4 65.9 69.0 68.6 69.7 70.5 72.0 74.7
Jordan 52.6 60.1 66.1 69.8 71.7 73.4 74.2 74.9 76.3 79.0
Kuwait 60.1 65.9 69.5 72.0 73.1 74.0 74.6 75.2 76.3 78.8
Lebanon 63.2 66.0 68.0 70.3 74.4 78.3 79.4 80.3 82.0 85.2
Libya 42.9 55.9 64.0 68.4 70.5 71.6 71.9 72.6 74.1 76.8
Mauritania 43.5 49.1 54.2 58.3 60.1 62.0 63.0 63.8 65.1 67.4
Morocco 48.5 52.6 57.7 64.6 68.8 73.9 75.5 76.7 78.9 82.6
Oman 42.6 50.4 59.7 67.1 72.1 75.6 76.8 77.9 80.1 83.8
Qatar 61.1 68.2 72.6 74.9 76.3 77.3 78.0 78.8 80.3 83.3
Saudi Arabia 45.7 52.9 62.9 68.9 72.3 73.6 74.4 75.2 76.6 79.6
Somalia 37.0 40.9 44.6 45.7 50.6 54.0 55.9 57.9 61.5 66.8
State of Palestine 49.5 55.8 62.7 68.0 70.7 72.4 73.3 74.2 75.8 78.7
Sudan 48.2 52.1 54.2 55.6 58.5 62.5 64.2 65.3 67.3 70.5
Syrian Arab Republic 52.0 58.8 65.7 70.5 73.1 72.2 70.6 73.7 78.3 81.0
Tunisia 42.2 51.2 61.8 68.7 73.1 74.8 75.6 76.5 78.3 81.6
United Arab Emirates 52.2 61.6 67.6 71.5 74.2 76.3 77.1 77.9 79.4 82.5
Yemen 34.7 41.2 50.6 57.7 60.4 63.5 64.7 65.7 67.5 70.4
Arab Region 46.8 52.5 58.5 64.2 67.6 70.0 71.0 72.0 73.7 76.4
Annex 4A: Life Expectancy at Birth (Both Sexes - in Years)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
39
Country 1970 1980 1990 2000 2010 2020 2030 2040 2050
Algeria 49.6 57.1 65.0 68.9 73.4 75.7 77.6 79.5 81.4
Bahrain 61.3 68.2 71.4 73.6 75.3 76.6 77.9 79.3 80.7
Comoros 44.1 49.1 55.0 57.9 60.3 62.7 64.4 65.6 66.8
Djibouti 47.7 52.1 55.0 55.6 58.8 61.5 63.1 64.4 65.7
Egypt 50.5 56.2 62.2 66.1 68.2 69.9 71.4 72.8 74.3
Iraq 58.1 57.2 62.4 66.7 66.0 68.2 69.5 70.7 72.0
Jordan 59.2 64.8 68.5 70.4 71.9 73.2 74.5 75.9 77.4
Kuwait 64.8 68.5 71.3 72.4 73.2 74.2 75.2 76.4 77.6
Lebanon 64.3 66.3 68.8 72.8 76.7 78.7 80.7 82.6 84.4
Libya 54.3 62.3 66.9 68.9 69.2 69.8 71.1 72.6 74.0
Mauritania 48.1 52.9 57.0 58.5 60.5 62.2 63.4 64.3 65.2
Morocco 51.6 56.4 63.0 67.2 72.5 75.5 77.6 79.6 81.6
Oman 49.2 58.0 65.3 70.3 73.8 76.3 78.5 80.7 82.9
Qatar 67.0 71.7 74.1 75.3 76.4 78.0 79.7 81.3 83.0
Saudi Arabia 51.0 61.1 67.4 70.8 72.3 73.9 75.4 76.9 78.4
Somalia 39.4 43.1 44.2 49.1 52.5 56.2 59.7 62.1 64.5
State of Palestine 54.0 61.0 66.4 69.1 70.7 72.2 73.7 75.3 76.8
Sudan 50.7 52.8 54.1 56.7 60.9 63.6 65.4 66.8 68.2
Syrian Arab Republic 57.5 64.5 69.0 71.0 68.2 69.5 76.1 77.5 79.0
Tunisia 50.1 60.6 66.7 70.8 72.7 74.5 76.3 78.2 80.0
United Arab Emirates 59.8 66.4 70.6 73.4 75.6 77.2 78.7 80.3 81.9
Yemen 39.9 49.0 56.1 59.1 62.1 64.2 65.7 67.0 68.2
Arab Region 51.3 56.8 62.3 65.8 68.2 70.1 71.8 73.1 74.4
Annex 4B: Life Expectancy at Birth (Males - in Years)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
40
Country 1970 1980 1990 2000 2010 2020 2030 2040 2050
Algeria 51.3 59.5 68.1 71.8 75.8 78.2 80.1 81.7 83.3
Bahrain 65.8 71.2 73.6 75.4 77.1 78.6 79.9 81.2 82.4
Comoros 47.3 52.3 58.1 61.0 63.5 66.3 68.3 70.0 71.6
Djibouti 50.5 55.2 58.2 58.7 61.9 64.9 66.9 68.7 70.4
Egypt 54.0 60.5 66.9 70.9 72.6 74.6 76.3 77.8 79.3
Iraq 57.7 64.2 69.5 71.4 71.3 72.9 74.6 76.1 77.5
Jordan 61.2 67.6 71.3 73.3 75.1 76.7 78.2 79.5 80.8
Kuwait 67.7 71.1 73.3 74.3 75.1 76.6 77.9 79.1 80.3
Lebanon 67.9 69.8 71.9 76.1 80.3 82.0 83.5 84.8 86.2
Libya 57.6 66.0 70.3 72.4 74.4 75.6 77.1 78.4 79.7
Mauritania 50.2 55.6 59.6 61.6 63.5 65.4 67.0 68.3 69.6
Morocco 53.6 58.9 66.2 70.3 75.2 77.9 80.1 81.8 83.5
Oman 51.6 61.3 69.1 74.4 78.1 80.3 82.2 83.7 85.3
Qatar 69.8 73.7 76.1 77.7 79.0 80.5 81.8 83.1 84.3
Saudi Arabia 54.9 64.8 70.9 74.2 75.2 77.0 78.6 80.0 81.3
Somalia 42.5 46.2 47.2 52.3 55.7 59.7 63.4 66.3 69.1
State of Palestine 57.7 64.4 69.5 72.4 74.3 76.2 77.9 79.3 80.7
Sudan 53.6 55.7 57.1 60.3 64.2 67.0 69.2 71.1 72.9
Syrian Arab Republic 60.2 67.0 72.0 75.2 76.8 78.4 80.3 81.7 83.1
Tunisia 52.3 63.1 70.9 75.7 77.1 78.6 80.3 81.7 83.0
United Arab Emirates 63.9 69.6 73.0 75.6 77.8 79.4 80.8 82.2 83.5
Yemen 42.6 52.0 59.1 61.9 64.9 67.3 69.3 70.9 72.6
Arab Region 53.8 60.3 66.2 69.6 72.0 74.0 75.7 77.1 78.5
Annex 4C: Life Expectancy at Birth (Females - in Years)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
41
Region, Subregion or Country 1970 1980 1990 2000 2010 2015 2020 2030 2050
World 16.3 17.2 18.0 18.8 20.0 20.5 20.9 21.7 23.1
More developed regions 18.0 19.0 19.9 20.7 22.5 23.2 23.7 24.8 26.8
Less developed regions 14.9 16.0 16.7 17.7 18.7 19.2 19.7 20.6 22.2
Least developed countries 13.6 14.3 15.0 16.0 17.1 17.6 18.0 18.7 20.3
High-income countries 18.0 19.2 20.5 22.0 23.6 24.2 24.8 25.8 27.8
Middle-income countries 15.3 16.3 16.9 17.6 18.7 19.2 19.6 20.5 22.2
Low-income countries 13.6 14.4 15.0 15.5 16.6 17.1 17.4 18.1 19.5
Algeria 14.7 15.8 17.2 18.9 21.2 21.8 22.3 23.2 25.1
Bahrain 15.3 16.3 17.4 18.3 19.2 19.7 20.2 21.1 23.3
Comoros 13.8 14.5 15.3 15.7 16.0 16.3 16.5 16.8 17.4
Djibouti 15.1 15.8 16.4 16.7 17.3 17.6 17.7 17.9 18.3
Egypt 16.5 16.8 17.0 17.1 17.2 17.4 17.8 18.8 20.6
Iraq 15.5 16.2 17.3 17.7 17.3 17.6 17.8 18.3 19.7
Jordan 15.7 16.7 17.5 18.1 18.8 19.2 19.6 20.4 22.2
Kuwait 15.9 16.3 16.6 17.0 17.5 17.8 18.2 19.0 21.0
Lebanon 16.7 17.0 17.6 19.2 21.6 22.4 23.0 24.3 26.9
Libya 14.9 16.2 17.1 17.6 18.2 18.4 18.7 19.4 20.9
Mauritania 14.1 15.0 15.7 16.0 16.4 16.5 16.6 16.8 17.3
Morocco 15.0 15.7 16.8 17.6 19.8 20.4 21.0 22.1 24.8
Oman 14.3 15.5 17.0 18.5 20.2 21.0 21.7 23.2 25.9
Qatar 17.9 18.9 19.5 19.8 20.3 20.9 21.4 22.6 25.0
Saudi Arabia 15.2 16.5 17.4 18.0 18.2 18.6 19.1 20.0 22.2
Somalia 13.6 14.4 14.6 15.5 16.0 16.2 16.4 16.7 17.2
State of Palestine 15.1 16.2 17.1 17.8 18.4 18.7 19.1 20.0 21.9
Sudan 15.6 16.0 16.3 16.8 17.5 17.8 17.9 18.0 18.4
Syrian Arab Republic 15.8 16.8 17.8 18.8 19.3 19.3 20.0 21.6 23.6
Tunisia 14.4 15.9 17.5 18.9 19.6 20.0 20.6 21.7 24.0
United Arab Emirates 15.5 16.4 17.5 18.5 19.6 20.1 20.6 21.8 24.3
Yemen 13.7 14.9 15.7 15.9 16.2 16.3 16.5 16.8 17.5
Arab Region 15.5 16.2 16.9 17.6 18.5 18.9 19.3 20.2 22.0
Annex 5: Life Expectancy at Age 60 (Both Sexes - in Years)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
42
Region, Subregion or Country 1970 1980 1990 2000 2010 2015 2020 2030 2050
World 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
More developed regions 5120.9 6269.9 9148.6 14529.9 13790.4 11560.5 11629.9 11718.7 11428.0
Less developed regions -5120.9 -6269.9 -9148.6 -14529.9 -13790.4 -11560.5 -11629.9 -11718.7 -11428.0
Least developed countries -2812.7 -4965.3 -1258.9 -3976.3 -7650.3 -5548.7 -4714.4 -4278.4 -4149.5
High-income countries 6138.8 7210.0 10070.1 16360.9 19152.8 15257.3 13611.4 12957.6 12412.0
Middle-income countries -5403.1 -3115.2 -9054.6 -14984.2 -16538.0 -13079.9 -11464.2 -10749.7 -10247.8
Low-income countries -681.1 -4104.3 -1042.4 -1446.3 -2586.0 -2167.1 -2164.8 -2231.5 -2187.9
Algeria -184.6 -152.9 -111.0 -184.8 -250.3 -96.6 -50.0 -50.0 -48.8
Bahrain 5.5 26.1 9.2 97.3 157.0 138.5 155.0 47.5 19.5
Comoros -5.5 2.8 -3.8 -8.0 -10.0 -10.0 -10.0 -10.0 -9.8
Djibouti 30.0 50.6 22.5 0.5 2.3 5.3 4.5 4.5 4.4
Egypt -393.2 -476.7 -336.3 -142.7 -279.3 -275.0 -275.0 -225.0 -219.4
Iraq -7.7 -123.9 -392.1 -142.1 3.2 251.4 -6.5 -56.2 -29.3
Jordan 112.3 0.4 291.5 -122.0 812.6 487.6 -300.0 -295.0 -19.5
Kuwait 121.2 128.2 -267.6 134.3 574.8 385.0 85.0 65.0 43.9
Lebanon -40.0 -242.2 -69.0 260.3 716.7 550.0 -425.0 -310.0 -19.5
Libya 53.3 85.5 4.7 -39.0 -276.0 -221.7 -10.0 -10.0 -9.7
Mauritania -4.4 -12.9 -30.1 10.0 25.0 32.8 22.9 15.3 14.9
Morocco -487.7 -307.0 -442.6 -607.1 -436.1 -282.1 -257.1 -257.1 -250.7
Oman 10.2 79.0 57.9 -89.2 542.3 711.3 357.5 30.0 19.5
Qatar 27.7 65.2 23.7 121.7 721.7 401.0 165.0 95.0 58.5
Saudi Arabia 339.4 1106.5 310.0 190.0 1292.5 1090.0 445.0 300.0 195.0
Somalia 1.0 734.7 -603.0 -142.4 -206.6 -213.3 -174.8 -149.8 -146.1
St. of Palestine -157.9 -72.6 -2.2 -60.0 -66.9 -38.3 -28.9 -25.0 -24.4
Sudan 10.0 200.0 401.7 -589.5 -833.8 -419.7 -150.0 -50.0 -48.8
Syria -48.8 -124.3 -108.3 -255.0 -1893.9 -2698.9 770.0 715.0 -48.7
Tunisia -96.8 6.8 94.7 -87.9 -49.5 -43.0 -20.0 -20.0 -19.5
UAE 159.5 286.0 314.7 822.7 1905.5 390.5 295.5 275.0 243.8
Yemen -299.3 -62.5 282.5 -106.1 -70.4 -112.5 -150.0 -135.0 -97.5
Arab Region -855.7 1196.8 -552.7 -938.9 2380.7 32.1 443.1 -45.8 -392.1
Annex 6: Net Number of Migrants, Both Sexes Combined (Thousands)
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
0
0-14 15-24 25-59 60+ 0-14 15-24 25-59 60+ 0-14 15-24 25-59 60+ 0-14 15-24 25-59 60+
Algeria 6818 2688 4215 829 11424 6615 18268 3564 12049 8423 21872 6478 11444 7195 25576 13222
Bahrain 95 38 71 9 286 181 849 57 336 245 1247 185 313 247 1362 405
Comoros 103 40 76 12 312 154 274 37 378 209 410 64 440 260 630 133
Djibouti 72 30 51 6 297 191 383 57 300 193 537 103 271 194 640 203
Egypt 14717 6569 11449 2311 31075 16343 39134 7226 35282 21817 50817 11831 39047 23637 67061 23689
Iraq 4424 1784 3060 650 14685 7103 12515 1812 19800 10331 19994 3172 26385 14724 32927 7454
Jordan 791 310 533 85 3300 1758 3596 506 3317 2064 4771 970 3387 2197 6426 2178
Kuwait 329 136 260 22 822 447 2506 160 929 651 2707 588 964 646 2876 1158
Lebanon 963 422 739 173 1404 1140 2637 671 1013 603 2731 1022 746 622 2356 1688
Libya 987 354 690 103 1783 1080 2969 402 1651 1212 3673 806 1475 999 3801 1848
Mauritania 529 210 361 50 1683 811 1482 206 2221 1170 2308 377 2843 1615 3718 789
Morocco 7614 2666 4871 849 9626 6045 15668 3464 9549 6370 18519 6435 8503 5774 20406 10977
Oman 335 134 217 38 931 617 2490 161 1116 813 3547 422 997 701 3686 1373
Qatar 40 23 44 3 343 363 1718 58 427 376 2151 278 428 360 2296 689
Saudi Arabia 2581 1072 1868 316 8204 4881 16819 1653 8656 5465 21003 4356 7567 5255 21911 10323
Somalia 1491 645 1127 181 6490 2767 4049 602 9513 4313 6747 962 13666 7138 13166 1883
State of Palestine 556 208 312 49 1871 1014 1566 211 2391 1291 2634 423 2763 1675 4245 1022
Sudan 4760 1916 3116 490 16034 7772 12764 2078 20122 10834 20343 3544 25287 14713 33685 6700
Syrian Arab Republic 3053 1193 1783 321 7136 3712 6695 1192 7488 5099 11536 2486 7456 5084 16021 5461
Tunisia 2302 892 1577 290 2671 1753 5534 1316 2753 1862 5953 2273 2470 1617 6122 3675
United Arab Emirates 83 48 100 5 1262 934 6779 179 1336 1290 7532 896 1583 1200 7920 2461
Yemen 2772 1198 1921 304 10920 5917 8866 1213 12551 7392 14951 1921 12368 8291 22887 4758
All Arab countries 55413 22575 38440 7095 132562 71598 167560 26826 153179 92023 225980 49594 170404 104144 299715 102087
Source: The United Nations World Population Prospects (2017), Medium Variant.
Annex 7: Population (Both Sexes - in Thousands) by Broad Age Group
Country 1970 2015 2030 2050
1
Country Age Group 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
0-14 46.9 46.3 43.3 34.3 27.2 28.7 29.7 24.7 20.5 19.9
15-24 18.5 20.2 20.6 22.7 20.7 16.6 13.6 17.3 15.6 12.5
25-59 29.0 28.2 30.9 36.6 44.3 45.8 46.6 44.8 46.2 44.5
60+ 5.7 5.3 5.2 6.4 7.8 8.9 10.1 13.3 17.7 23.0
0-14 44.8 34.6 32.7 30.1 20.3 20.8 18.2 16.7 15.4 13.5
15-24 17.9 22.1 16.4 16.6 15.0 13.2 11.0 12.2 11.4 10.6
25-59 33.3 39.6 47.2 49.4 61.1 61.9 65.4 61.9 59.0 58.5
60+ 4.1 3.7 3.7 3.8 3.5 4.1 5.4 9.2 14.3 17.4
0-14 44.6 44.8 45.9 44.0 41.0 40.1 39.0 35.6 32.5 30.1
15-24 17.4 19.6 18.9 20.2 20.6 19.9 19.5 19.7 18.9 17.8
25-59 32.8 30.4 30.2 31.1 33.9 35.3 36.4 38.6 41.4 43.0
60+ 5.1 5.2 4.9 4.7 4.5 4.7 5.1 6.1 7.2 9.1
0-14 45.4 46.5 45.0 41.0 34.8 32.0 29.7 26.5 23.3 20.7
15-24 18.8 20.4 19.7 20.5 21.7 20.6 19.5 17.1 16.0 14.8
25-59 31.8 29.3 31.1 33.8 37.7 41.3 43.9 47.4 48.8 48.9
60+ 4.0 3.9 4.2 4.8 5.8 6.2 6.9 9.1 11.8 15.6
0-15 42.0 40.9 41.0 36.6 32.1 33.1 33.2 29.5 26.9 25.4
15-25 18.7 19.1 18.2 20.4 20.3 17.4 16.4 18.2 17.0 15.4
25-60 32.7 33.2 33.8 35.8 40.1 41.8 42.2 42.4 43.9 43.8
60+ 6.6 6.8 7.0 7.2 7.5 7.7 8.2 9.9 12.2 15.4
0-14 44.6 46.8 45.9 43.0 41.7 40.7 39.9 37.2 34.6 32.4
15-24 18.0 18.0 21.1 20.9 19.8 19.7 19.3 19.4 18.8 18.1
25-59 30.9 29.0 27.5 30.9 33.8 34.7 35.9 37.5 38.9 40.4
60+ 6.5 6.2 5.5 5.2 4.8 5.0 5.0 6.0 7.6 9.1
0-14 46.0 49.0 45.8 39.5 37.0 36.0 34.4 29.8 26.4 23.9
15-24 18.0 19.6 21.6 21.3 19.5 19.2 18.7 18.6 17.0 15.5
25-59 31.0 26.7 27.8 34.4 38.1 39.3 40.8 42.9 44.5 45.3
60+ 4.9 4.7 4.8 4.9 5.4 5.5 6.0 8.7 12.1 15.4
0-14 44.1 40.3 34.9 28.4 23.2 20.9 21.3 19.1 17.2 17.1
15-24 18.2 18.0 17.8 16.2 15.2 11.4 12.2 13.4 12.7 11.5
25-59 34.8 39.2 45.1 52.4 58.2 63.7 60.3 55.5 51.9 51.0
60+ 3.0 2.5 2.2 3.0 3.4 4.1 6.1 12.1 18.2 20.5
0-14 41.9 39.0 34.1 28.6 23.7 24.0 21.6 18.9 16.5 13.8
15-24 18.4 20.6 19.2 19.1 20.0 19.5 17.0 11.2 11.6 11.5
25-59 32.2 33.1 37.5 41.9 44.4 45.1 48.2 50.9 48.3 43.5
60+ 7.5 7.3 9.2 10.4 11.9 11.5 13.1 19.0 23.6 31.2
0-15 46.2 47.9 41.7 33.8 28.4 28.6 27.2 22.5 19.2 18.2
15-25 16.6 17.5 21.4 22.6 20.0 17.3 16.3 16.5 14.4 12.3
25-60 32.4 30.1 31.9 37.9 45.6 47.6 49.4 50.0 48.7 46.7
60+ 4.8 4.5 5.0 5.7 6.0 6.5 7.1 11.0 17.7 22.8
0-14 46.0 45.3 44.8 43.1 41.2 40.2 39.3 36.6 33.9 31.7
15-24 18.3 19.8 19.9 20.1 19.7 19.4 19.1 19.3 18.8 18.0
25-59 31.4 30.1 30.4 31.9 34.3 35.4 36.3 38.0 39.8 41.5
60+ 4.3 4.7 5.0 4.9 4.8 4.9 5.3 6.2 7.5 8.8
Djibouti
Annex 8: Population by Broad Age Groups (in %)
Comoros
Lebanon
Kuwait
Jordan
Bahrain
Mauritania
Algeria
Egypt
Libya
Iraq
2
Country Age Group 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
60+ 47.6 43.3 39.7 33.5 28.5 27.7 26.7 23.4 20.3 18.6
0-15 16.7 21.8 20.6 20.9 19.2 17.4 15.8 15.6 14.4 12.6
15-25 31,4 30,1 30,4 31,9 34,3 35,4 36,3 38,0 39,8 41,5
25-60 5.3 5.1 6.6 7.7 8.6 10.0 11.9 15.7 19.5 24.0
0-14 46.3 45.1 45.2 37.1 25.7 22.2 21.2 18.9 15.5 14.8
15-24 18.6 17.6 15.9 21.4 21.1 14.7 12.2 13.8 13.4 10.4
25-59 29.9 33.0 35.3 37.5 49.3 59.3 62.3 60.1 58.5 54.6
60+ 5.2 4.3 3.5 4.0 3.9 3.8 4.2 7.1 12.6 20.3
0-14 36.1 33.7 28.3 25.7 13.1 13.8 14.0 13.2 11.9 11.4
15-24 20.8 20.1 13.8 13.8 14.5 14.6 12.4 11.6 10.6 9.6
25-59 39.9 43.6 55.6 57.5 70.6 69.2 70.0 66.6 63.9 60.8
60+ 3.2 2.6 2.3 3.0 1.8 2.3 3.6 8.6 13.6 18.2
0-14 44.2 43.6 42.0 38.2 29.8 26.0 24.3 21.9 18.1 16.8
15-24 18.4 17.8 18.4 18.2 18.6 15.5 13.2 13.8 14.1 11.7
25-59 32.0 33.9 35.3 39.2 47.2 53.3 56.1 53.2 50.0 48.6
60+ 5.4 4.7 4.3 4.4 4.5 5.2 6.4 11.0 17.9 22.9
0-14 43.3 43.8 44.1 47.1 47.7 46.7 46.0 44.2 41.2 38.1
15-24 18.7 19.0 19.4 17.7 19.0 19.9 20.1 20.0 20.3 19.9
25-59 32.7 32.1 31.8 30.9 29.1 29.1 29.5 31.3 33.8 36.7
60+ 5.3 5.1 4.7 4.3 4.3 4.3 4.4 4.5 4.7 5.3
0-14 49.4 49.9 48.6 47.8 42.4 40.1 38.9 35.5 31.5 28.5
15-24 18.5 19.2 20.1 19.5 21.6 21.7 20.2 19.2 18.8 17.3
25-59 27.8 27.5 28.0 29.0 31.6 33.6 36.1 39.1 41.7 43.7
60+ 4.3 3.5 3.4 3.7 4.3 4.5 4.8 6.3 8.1 10.5
0-14 46.3 47.1 45.5 43.8 43.0 41.5 39.7 36.7 34.2 31.5
15-24 18.6 18.8 20.0 19.9 19.3 20.1 20.5 19.8 18.8 18.3
25-59 30.3 29.5 30.0 31.5 32.6 33.0 34.1 37.1 39.7 41.9
60+ 4.8 4.6 4.6 4.8 5.1 5.4 5.7 6.5 7.3 8.3
0-14 48.1 49.0 47.1 41.0 36.4 38.1 34.2 28.1 25.0 21.9
15-24 18.8 19.8 20.5 22.3 20.9 19.8 22.6 19.2 16.1 14.9
25-59 28.1 26.7 27.7 31.9 37.6 35.7 35.6 43.4 46.6 47.1
60+ 5.1 4.6 4.7 4.8 5.1 6.4 7.6 9.3 12.3 16.1
0-14 45.5 41.7 37.2 29.5 23.3 23.7 24.1 21.4 18.1 17.8
15-24 17.6 20.9 19.7 20.3 18.7 15.5 13.5 14.5 14.2 11.6
25-59 31.2 31.4 35.7 40.5 47.6 49.1 49.0 46.4 46.1 44.1
60+ 5.7 6.0 7.5 9.6 10.4 11.7 13.4 17.7 21.7 26.5
0-14 35.1 28.0 30.9 26.0 13.4 13.8 13.9 12.1 12.1 12.0
15-24 20.2 17.9 15.7 15.9 13.5 10.2 11.0 11.7 9.4 9.1
25-59 42.4 52.2 51.4 56.4 71.6 74.1 71.9 68.1 64.1 60.2
60+ 2.3 2.0 1.9 1.7 1.5 2.0 3.2 8.1 14.4 18.7
0-23 44.7 49.5 51.9 48.6 42.5 40.6 38.8 34.1 29.4 25.6
15-33 19.3 18.1 18.6 20.1 22.9 22.0 20.5 20.1 19.0 17.2
25-68 31.0 27.9 25.7 26.9 30.3 32.9 36.0 40.6 45.0 47.4
60+ 4.9 4.5 3.9 4.3 4.4 4.5 4.7 5.2 6.7 9.8
100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0
Yemen
Total (of each country)
Source: United Nations World Population Prospects (2017), Medium Variant.
Annex 8: Population by Broad Age Groups (in %) - Continued
State of Palestine
Sudan
Syria
Tunisia
UAE
Morocco
Oman
Qatar
Saudi Arabia
Somalia
3
Country 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
Algeria 90 85 88 94 94 98 99 96 95 95
Bahrain 118 128 116 103 124 128 136 134 151 140
Comoros 82 81 81 83 86 87 87 88 87 87
Djibouti 84 83 85 88 89 88 90 93 91 90
Egypt 77 78 79 80 81 84 85 85 86 86
Iraq 90 92 90 88 86 84 81 79 82 83
Jordan 99 101 100 103 94 93 90 94 96 94
Kuwait 108 119 145 137 140 170 174 141 122 104
Lebanon 92 90 98 93 105 98 99 115 109 96
Libya 107 101 102 100 92 89 86 86 87 83
Mauritania 90 84 82 79 76 80 84 88 90 91
Morocco 86 86 86 81 87 90 92 91 85 86
Oman 92 84 73 99 122 107 121 168 178 170
Qatar 106 139 193 200 216 278 317 340 321 214
Saudi Arabia 90 92 100 105 114 131 148 166 144 124
Somalia 83 95 90 90 95 97 97 91 86 83
State of Palestine 100 89 82 89 95 92 90 88 88 89
Sudan 88 89 89 89 89 89 89 88 85 84
Syrian Arab Republic 103 94 95 89 95 87 83 83 83 84
Tunisia 99 106 97 100 88 87 87 85 82 83
United Arab Emirates 118 144 141 163 257 236 254 249 193 145
Yemen 81 77 74 94 91 90 88 82 87 87
Arab Region 86 86 87 88 90 92 94 97 96 93
Annex 9: Sex Ratio at 60 Years and Older (Males per 100 Females): 1970 - 2050
Source: Author's Calculations from the United Nations World Population Prospects (2017), Medium Variant
4
Country 1970 1980 1990 2000 2010 2015 2020 2030 2040 2050
Algeria 101.5 98.9 87.7 62.9 48.5 52.7 57.6 51.4 49.1 58.5
Bahrain 89.8 57.8 53.5 48.4 28.9 30.2 26.4 28.8 33.2 36.1
Comoros 90.9 92.3 96.4 88.7 78.6 75.5 72.8 65.2 59.0 55.9
Djibouti 91.6 95.4 90.8 78.5 62.6 56.5 51.8 47.9 44.9 44.5
Egypt 86.0 82.9 83.5 70.8 58.4 61.8 62.6 56.3 53.8 56.3
Iraq 94.6 103.8 98.7 86.6 81.8 77.7 76.2 68.7 65.3 62.7
Jordan 97.1 109.1 95.9 74.0 68.5 66.1 62.2 54.4 52.9 53.5
Kuwait 84.9 72.3 56.8 42.8 33.7 29.8 32.1 34.6 42.3 48.7
Lebanon 88.5 80.0 66.8 55.6 47.3 47.3 44.7 48.7 52.3 59.0
Libya 97.1 102.6 81.4 60.2 48.4 49.1 46.8 40.8 44.1 53.3
Mauritania 94.2 93.1 91.8 86.2 79.5 76.5 73.9 67.8 62.9 59.8
Morocco 104.2 87.2 77.3 63.4 53.0 51.6 52.3 52.9 52.8 57.9
Oman 97.9 91.6 90.6 65.4 39.6 32.4 31.1 30.5 30.9 39.9
Qatar 61.5 54.4 42.0 37.8 16.5 17.5 18.7 21.7 27.1 31.6
Saudi Arabia 91.1 87.2 81.2 70.1 48.7 40.9 39.0 39.9 42.3 50.3
Somalia 86.8 88.5 89.0 99.2 101.2 97.4 95.3 88.7 79.4 70.7
State of Palestine 109.5 108.8 102.8 100.4 82.2 75.8 72.5 65.2 58.3 55.1
Sudan 97.2 100.1 93.9 88.2 86.2 81.6 76.8 69.1 64.0 58.8
Syria 105.8 108.0 100.4 79.7 66.2 72.8 64.2 52.6 49.9 50.4
Tunisia 96.0 83.9 72.6 56.9 44.5 45.6 49.2 51.2 51.5 60.2
UAE 57.4 41.7 47.3 37.1 16.5 17.4 18.0 19.8 27.7 34.7
Yemen 91.6 109.8 119.1 105.9 82.4 76.8 71.9 60.0 50.1 46.1
Arab Region 94.5 92.3 87.5 74.7 62.7 62.0 61.3 56.6 54.5 56.2
Table 9: Total Dependency Ratio (%)
Source: The United Nations World Population Prospects (2017)
Notes: 1) Total Dependency Ratio= (Age 0-14 + Age 65+) / (Age 15-64).
2) De facto population as of 1 July of the year indicated.
3) Child and older ratios (in tables 10 and 11) may not sum to total ratio due to rounding.
Figure 7: Age pyramids of select youthful Arab countries: 1970, 2015, 2030 and 2050
5
Figure 7: Age pyramids of select youthful Arab countries: 1970, 2015, 2030 and 2050 (Continued)
6
Figure 7: Age pyramids of select youthful Arab countries: 1970, 2015, 2030 and 2050 (Continued)
7
Figure 7: Age pyramids of select youthful Arab countries: 1970, 2015, 2030 and 2050 (Continued)
8
CHAPTER 2
Socio Economic Situation of Older Persons
in the Arab Region
9
Introduction
Chapter 1 presented evidence of the quick transition of the Arab region towards ageing. The number
of older persons in the region today is close to 27 million. It will exceed 100 million in 2015
constituting more than 15% of the population. Even in countries that have a slow ageing rate including
Mauritania, Iraq, Comoros, Palestine and Yemen, where the proportion of older persons might not
increase significantly given the youthful societies, the number of older persons however will almost
quadruple by 2050.
These findings are a cause for alarm across the Arab region. The fulfillment of older persons’ human
rights is a societal responsibility and therefore a duty of the State. However, weak social protection
systems hinder the States’ ability form fulfilling this role. This role is further compounded by the
responsibility of the States to attend to the pressing needs of the youth, given the unprecedented youth
bulge, in parallel to the needs of the growing numbers of older persons.
Some Arab countries have recently started developing policies to address the shift in population
structures (Sibai and Yamout 2012) 27. The situation of older persons varies within countries and
across countries in the region. Nevertheless, they suffer from common vulnerabilities including low
levels of education and employment, weak pension coverage especially for employees in the informal
sector, limited participation in the economy, poor access to the credit market, and weak financial
security. Women, who constitute the larger group among older persons, are particularly vulnerable,
given higher illiteracy rates among them, higher economic dependency, and increased susceptibility
to non-communicable diseases (NCDs).
To add to the risk variables that threaten the wellbeing of older persons in the region, are the
protracted conflicts that have spread across several countries in the region. Conflict brings about far
more serious and dire problems for older persons, including death, injury, displacement, increased
dependency and isolation as a result of family fragmentation.
This chapter seeks to provide some insights on the socio-economic conditions of older persons in the
region. To this end, it begins with discussing social protection systems in the Arab region, presents
the findings of a set of indicators on the socio-economic conditions of older persons, and concludes
with highlighting some of the key findings.
It relies on quantitative analysis of a set of indicators, which cover the material dimension (pension
coverage), social aspects (health, education, activity, social and family connections), and exogenous
features (physical security, transportation). The data used to construct these indicators was taken
from national census, international institutions (ILO, UN, WHO, WB), in addition to households’
surveys for selected countries, namely Egypt, Jordan and Tunisia. One of the major challenges
faced, and a limitation of this chapter was finding data that is disaggregated by age and sex on
different issues related to the conditions of older persons including poverty, health expenditure,
pension benefits, income etc. Where national data was lacking, this chapter also relied on Gallup
survey data.
Social protection systems for older persons in Arab countries
Almost all Arab countries provide some level of social protection programs for health, education, and
pensions, however, the coverage and efficacy of these programs vary. When compared to other
27 Sibai, A. A., Tohme, R. A., Yamout, R. Yount, K. M., Kronfol, N. M. (2012). The older persons: From veneration to
vulnerability? In S. Jabbour, R. Giacaman, M. Khawaja, and I. Nuwayhid (Eds.). Public health in the Arab world
10
regions, the Arab region has relatively low levels of public social protection expenditure as percentage
of GDP (4.2% in Arab countries compared to 18.5% in Asia-Pacific countries) (figure 1)28.
Source: ILO Social Protection Department database.
Note: The data includes pensions and other cash and in-kind benefits for older persons
In fact, in a region, where the informal sector is one of the most significant and unemployment rates
among the highest in the world (mainly for young people and women), a majority of the population
risks or is subject to poverty and lacks access to sustainable health-care. With the exception of the
paternalistic social protection systems in place in oil-exporting Gulf countries, social protection in
Arab countries is contributory (Bismarckian), and primarily cover old-age and survivorship,
invalidity, and employment disability.
Social protection systems that cover social insurance, health, maternity care, elderly care,
unemployment, and illness-related assistance are not well-developed in the region and are mostly
limited to workers in the public, military personnel or formal private sector. Large segments of the
population are left without social protection, including workers in the informal sector, agricultural
and domestic workers, temporary workers, and migrant workers. Women are among the most
vulnerable, as they have limited or no access to social security benefits. Since most of those who are
employed, are employed in the informal sector or in unpaid work, they are not eligible for social
insurance (pension entitlement and health insurance programs) when they age.
The universality of coverage is limited even in countries that have higher public social protection
expenditure on pensions and other benefits for older persons such as Jordan (figure 1). Available
national household surveys that include information on social security coverage indicate that
protection for women living in rural area is lacking (such as the case of Jordan and Tunisia, table 1).
These groups are dependent on subsidies, charities and safety nets.
28 ILO, World Social Protection Report 2014/15: Building economic recovery, inclusive development and social justice
International Labour Office – Geneva: ILO, 2014.
0 1 2 3 4 5 6 7 8
Morocco
Egypt
Iraq
Tunisia
Algeria
Jordan
Bahrain
Kuwait
% of GDP
Figure 1: Non-Health Public Social Protection Expenditure on Pensions and Other Benefits for Older Persons in selected Arab countries ,
2010/11 (Percentage of GDP)
11
Social safety nets targeting poor, food insecure, and vulnerable individuals and households increased
in recent years following the 2007-2008 crisis. Net government spending across the region increased
from 10,1% to 12.5% (Marcus and Pereznieto, 2011). Cash social transfer systems through traditional
institutions such as Al Zakat are also well established in the region. How these institutions29 are
organized and function varies from country to country: public funds (Sudan), social funds (Egypt and
Yemen), or individual donations through specific funds (Algeria, Palestine, and Jordan). To
compensate for the absence of adequate public social protection systems, civil society in Arab states
had long been providing many services to the elderly poor.
Age
Urban Rural Urban Rural Urban Rural Urban Rural
Work Status
Employed 88.60% 92.47% 52.58% 79.70% 29.74% 20.11% 9.21% 16.85%
Out of the Labor Force 10.10% 7.16% 46.48% 19.87% 70.06% 79.89% 90.79% 83.15%
Work with Social Security Coverage 69.71% 47.60% 36.61% 8.13% 81.27% 28.09% 38.89% 1.67%
Age
Urban Rural Urban Rural Urban Rural Urban Rural
Work Status
Employed 64.60% 56.55% 53.50% 45.24% 6.67% 8.47% 4.66% 6.58%
Out of the Labor Force 31.64% 39.88% 44.44% 53.57% 93.33% 91.53% 95.34% 93.42%
Work with Social Security Coverage 48.29 48.42 22.31 13.16 57.14 0 33.33 0
Age
Urban Rural Urban Rural Urban Rural Urban Rural
Work Status
Employed 72% 79% 41% 66% 17% 18% 7% 20%
Out of the Labor Force 25% 17% 58% 33% 83% 82% 93% 78%
Work with Social Security Coverage 62% 51% 46% 28% 46% 0% 10% 3%
Table 1: Labor and Social Security Coverage in Egypt, Jordan and Tunisia
Source: ERF, ELMPS 2012, JLMPS 2010, TLMPS, 2014
EGYPT
Male Female
50-59 60+ 50-59 60+
JORDAN
Male Female
50-59 60 + 50-59 60 +
TUNISIA
Male Female
50-59 60 + 50-59 60 +
Socio-economic situation in old-age To assess the socio-economic sitation of older persons in the Arab region, this section follows the
Golbal AgeWatch Index developed by HelpAge International, and measures the wellbeing of older
persons in four key domains: income security, health status, capability, and enabling environment.
Based on data availability, the following indicators were used:
Pension coverage: This indicator is used as a proxy for income security. Income security is based
on the principle that older citizens should be guaranteed a minimum income that will allow them to
live decently.
12
• Life expectancy at 60 and healthy life expectancy at 60: are used as proxy indicators to
measure the health status at old age. Improving the health status of the elderly reinforces their
autonomy.
• Employment and Education status: serve as a proxy for older people's capabilities. It is linked
to vulnerability assessment in so far as (1) an individual's educational level impacts their
access to labor markets, (2) work income supplements or compensates the lack of pension
income, (3) working maintains a social network, and (4) the capacity to work reflects the
elderly person's physical aptitudes.
• Social and family connections, physical safety, access to public transportation, and housing
arrangements: These indicators are used as proxy for enabling environment. They demonstrate
the interaction between the elderly, their families, and society.
1. Pension coverage
Adequate social coverage is a prerequisite for the wellbeing of older persons, without which they face
a high risk of poverty and vulnerability. As discussed in the previous section, large groups of the
population do not have access to social security programs across the region. This situation is
particularly prevalent for women, self-employed individuals, agricultural workers, and for persons
working in the informal sector.
Only few people who have reached statutory pensionable ages receive a pension. Indeed, the average
pension coverage rate for the region does not exceed 30 % of the workforce (ILO, 2014) 30. As shown
in figure 2, the share of population receiving an old age pension benefits varies drastically between
Arab countries. It ranges from a low of 5% in Sudan to a high of 69% in Tunisia and 64% in Algeria.
On the high end of the spectrum, over 40% of the elderly population in Iraq, Saudi Arabia, and Egypt
benefited from pension coverage, while in high-income Gulf countries, pension income coverage was
40% in Bahrain, 27% in Kuwait, and 25% in Oman.
According to these figures, the majority of workers in these countries are without pension and health
coverage. At the bottom of the spectrum, the situation is the least favorable in Yemen, Palestine,
Mauritania, Qatar and Sudan with less than 10% pension income coverage.
30 ILO Social Security Inquiry. Indicator: old-age pensioners recipient ratio above retirement age available at
http://www.ilo.org/, June, 2014.
13
Source: United Nations, Department of Economic and Social Affairs, Population Division, 2015.
World Population Ageing, 2015 and Palestine, Palestinian Central Bureau of Statistics (PCBS),
2014.
Coverage rates are higher in countries such as Egypt and Tunisia that include the self-employed and
agricultural workers in the system. Egypt has special systems for self-employed workers, casual
workers and household workers. Tunisia has special systems for self-employed workers, agricultural
workers, farmers, household workers, artists, certain categories of fishermen, and low-income
earners.
Furthermore, the labor market in this region is characterized by an abundance of migrant workers. It
is therefore important to distinguish between national and non-national workers. The GCC sub-
region (Bahrain, Oman, Saudi Arabia, Kuwait, and the United Arab Emirates), which is the primary
destination for migrant workers in the region, excludes foreign workers from coverage under their
social security programs.
For selected countries, where national surveys are available with information about poverty levels, a
high percentage of the elderly are living in poverty is observed (table 3). Important differences exist
between those countries. Sudan, Jordan, Egypt and Iraq show the highest poverty levels. Furthermore,
and as expected, there is a gender difference. Women, more often widowed compared to men, are
also poorer. One would expect that poverty is more severe for women living alone and in rural areas,
for example world bank data on poverty rates for female and male-headed households in Egypt (2012)
showed higher rated of poverty among rural versus urban households. It also showed that poverty is
higher in female headed urban households than male headed ones31. Unfortunately, data available
about poverty dissagregated by gender and broken down geographically by area of residence remains
31 Poverty rates for female and male-headed households in Egypt. Wolrd Bank (2012). Available at:
http://siteresources.worldbank.org/INTMENA/Resources/Presentationdiscussant.pdf
0
10
20
30
40
50
60
70
80
Figure 2: Share of Population Above Statutory Pensionable Age Receiving an Old Age Pension in Arab Countries (%)
14
very limited. More data is needed to evaluate poverty in Arab countries, especially poverty among
older persons, and older women in particular.
In Palestine, coverage includes workers in the Public sector and non-governmental organizations
exclusively. Formal old-age assistance programs are available primarily through the Ministry of
Social Affairs (MOSA), UNRWA programs, and aids programs funded principally by the European
Union and the World Bank. However, these programs are limited in scope and depend entirely on
foreign donors, they cannot therefore guarantee beneficiaries either a regular income or sustainable
payments.
In Palestine, as in other conflict ridden countries, financial security is further threatened due to
instability and the possibility of the loss of physical assets including homes and other property and
lifelong earnings. Pension funds are also at risk given the economic volatility in these countries,
such as severe devaluation of currency.
Egypt Iraq Jordan Kuwait Lebanon Morocco Oman Palestine Sudan Tunisia
Male -100.0% 15.0% 6.2% 9.3% N/A 4.8% 10.9% 8.0% -100.0% 6.7%
Female -100.0% 57.7% 43.1% 59.5% N/A 49.6% 59.8% 49.4% -100.0% 44.8%
Male 58.4% 55.9% 66.0% N/A 36,30% 3.0% N/A 22.4% 96.8% N/A
Female 58.7% 44.1% 6.6% N/A 40.5% N/A N/A 22.1% 96.9% N/A
Table 2: Marital Status and Poverty in Old-Age
Divorced or
widowed
Source: MIPAA. Based on the results of a questionnaire on the “Third Regional Review of the Madrid International Plan of Action on Ageing, 2002”
undertaken in ESCWA member countries in 2017.
Note: *Percentage of people 60 years or older living with under $1.9 a day.
Old people living
in poverty*
Until now, the elderly in most Arab countries have benefited from intergenerational solidarity.
Nuclear and extended families have played a key role in social and financial support, particular in
caring for dependents such as, elderly relatives or disabled.
However, current demographic trends and societal changes predict a negative impact the tradition
system of informal care where family and children played a central role in providing assistance to the
elderly. Therefore, improving pension coverage becomes a priority to ensure the wellbeing of older
persons. Intergenerational support is further discussed in chapter 3 of this report.
2. Health
a- The evolution of life expectancy in Arab countries
The population of older people in the Arab countries has been increasing rapidly since the 1980s. As
is the case for most developed countries, we observe significant gains in life expectancy at age 60 in
the Arab region. There is evidence of a gender-based life expectancy gap in all Arab countries: female
life expectancy is considerably higher than male life expectancy (figures 3 -4).
As life expectancy increases in all Arab countries (Chapter 1, Figure 4), quality of life and health
issues become a growing concern for the elderly. Although people are living longer, the elderly are
not necessarily in good health. Figure 3 compares life expectancy at age 60 with healthy life
expectancy at age 60 for all Arab countries. The highest life expectancy at age 60 is 22 years in
Lebanon while the highest healthy life expectancy observed is around 15 years, in UAE, Qatar, and
Algeria.
Reflecting what is a global phenomenon, women in Arab countries now live longer but at the same
time experience poorer health conditions in old age (Al Hazzouri et al., 2011; Abdulrahim et al.,
2013). In fact, while the average female life expectancy at age 60 is around 20 years, the average
healthy female life expectancy at 60 is barely 14 years (figure 4).
Poor health means that the older persons will incur higher health expenses that they must bear
individually or via their families, if they are not covered by social security programs. Indeed, in most
15
Arab countries, the uninsured have to pay for their medical treatments out of pocket, as shall be
demonstrated later in this chapter.
0
5
10
15
20
25
Figure 3: Healthy Life Expectancy and Life Expectancy at Age 60 in Arab Countries
Life expectancy at 60 (years) Healthy life expectancy at 60 (years) Tot
Source: WHO - 2012. Data for Palestine: 2010.
0
5
10
15
20
25
Figure 4: Healthy Life Expectancy at 60 by Gender
Life expectancy at 60 (years), female Life expectancy at 60 (years), Male Healthy life expectancy at 60 (years), Male Healthy life expectancy at 60 (years), Female
Source: WHO - 2012. Data for Palestine: 2010.
16
b- Epidemiological transition
The demographic transition of the Arab countries is associated with a rapid epidemiological transition
toward noncommunicable diseases (NCDs)32, in part driven by population ageing. Thus, the burden
of diseases related to NCDs has grown rapidly. Data for the Arab region referring to 2008 show that
“more than 1.2 million people in the Arab world died from non-communicable diseases, accounting
for nearly 60 per cent of all deaths in the region, with wide variations between countries (ranging
from 27 per cent in Somalia to about 84 per cent in Oman and Lebanon)”.33
Similarly, statistics based on the Pan Arab Project for family Health (PAPFAM) surveys in nine Arab
countries reveal that the percentage of older adults suffering from at least one chronic disease ranged
between 13.1 per cent in Djibouti and 63.8 per cent in Lebanon, with the majority of the countries
having rates above 45 per cent.34
Among the older people aged 60 and above, more than 823,000 died from these diseases. The share
of deaths of older persons from non-communicable diseases is very important, ranging from 90.4 per
cent in Bahrain to 72.8 per cent in Mauritania. In fact, the primary causes of death for adults have
shifted to cardiovascular disease and cancer, with shares of death ranging from 34.4 per cent in
Bahrain to 60 per cent in Oman for cardiovascular disease and from 5.7 per cent in Sudan to 20.4 per
cent in Qatar for cancer (Table 1).
While data on mental health of older persons in the Arab region is still scarce, data indicates that
depression and dementia are a growing concern particularly in fast ageing countries such as Lebanon
and Tunisia35. Furthermore, disability is frequent in old age and is observed among the poorest
populations. We observe for all Arab countries that women are more prone to disability than men
(table 6). The disability rate is highest in Morocco, Palestine and Yemen. For instance, in Morocco,
women are 5 per cent more likely to be disabled than men. In Yemen and Palestine, this figure is
respectively 4 % and 2 %.
These indicators should raise red flags for policy makers given that “the cumulative effect of chronic
disease throughout the life course and the age-related decline in physiological reserves in old age
contribute to the onset of frailty, disability and dependency in the ageing population.”36
32Noncommunicable diseases (NCDs), also known as chronic diseases, do not result from an
(acute) infectious process and hence are “not communicable. The main types of NCDs are cardiovascular diseases (like
heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and
asthma) and diabetes”. See for example: http://www.who.int/mediacentre/factsheets/fs355/en/ 33 ESCWA; Arab Society: A compendium of social statistics. Issue No. 12 (E/ESCWA/SD/2015/4; 1 December 2015) 34 Kronfol, N Global Health on Ageing & Non-Communicable Diseases. HUMAN & HEALTH | N°24 - July 2013
http://www.syndicateofhospitals.org.lb/Content/uploads/SyndicateMagazinePdfs/1838_10-17%20Eng.pdf [Accessed
25/08/2017] 35 Yount KM, Sibai AM. Demography of Ageing in Arab Countries. International Handbook of Population Ageing
2009;(1):277-315 36 Op.cit Kronfol, N Global Health on Ageing & Non-Communicable Diseases
17
TotalMalignant
neoplasms
Diabetes
mellitus
Cardiovascular
diseases
Respiratory
diseases
Digestive
diseases
Algeria 100.0 21.0 75.2 9.4 5.2 40.0 8.5 4.2 3.8
Bahrain 100.0 8.4 90.4 13.1 17.7 34.4 8.3 3.8 1.2
Comoros 100.0 21.3 75.7 7.3 8.6 39.3 8.9 3.5 3.0
Djibouti 100.0 12.6 84.9 7.4 2.4 53.0 5.4 8.0 2.5
Egypt 100.0 5.0 93.8 9.4 3.2 52.6 3.9 14.6 1.3
Iraq 100.0 9.5 80.6 8.7 2.0 52.8 5.1 5.3 9.9
Jordan 100.0 5.9 91.1 10.4 10.4 55.5 4.3 3.9 2.9
Kuwait 100.0 9.0 88.0 14.9 5.8 56.8 2.4 3.5 3.0
Lebanon 100.0 4.0 91.0 16.4 1.9 54.9 5.6 5.2 5.0
Libya 100.0 5.8 90.1 11.4 2.2 58.3 5.0 5.9 4.1
Mauritania 100.0 23.9 72.8 8.0 5.8 38.3 8.6 4.6 3.3
Morocco 100.0 4.9 92.0 8.8 2.2 58.1 6.3 7.6 3.1
Oman 100.0 1.0 97.4 11.0 9.9 60.0 4.3 4.3 1.6
Qatar 100.0 5.1 91.5 20.4 14.9 35.5 6.7 3.7 3.4
Saudi Arabia 100.0 8.6 89.3 9.0 9.2 55.5 4.1 4.1 2.2
Somalia 100.0 14.9 80.1 7.2 3.5 47.7 6.3 6.7 4.9
Sudan 100.0 10.0 86.8 5.7 3.8 53.4 7.0 7.2 3.1
Syrian Arab Republic 100.0 5.0 91.9 6.7 3.2 58.4 6.0 3.6 3.1
Tunisia 100.0 15.3 81.9 13.3 1.7 50.2 5.1 5.0 2.7
United Arab Emirates 100.0 14.1 82.6 11.9 6.1 50.1 4.0 2.8 3.3
Yemen 100.0 8.1 88.4 8.5 2.3 55.3 5.9 7.6 3.5
All Arab Countries 100.0 9.0 87.8 8.9 3.7 52.3 5.6 8.3 3.2
Injuries
Country
Table 1: Distribution of Major Causes of Death of Older Persons (60+)
Source: Author’s calculations from the World Health Organization, Department of Measurement and Health Information, April 2011, and from Mortality
and Burden of Disease Estimates for 2008.
All
Causes
Communicable,
maternal,
perinatal and
nutritional
conditions
Noncommunicable diseases
Country Both Sexes Males Females Year
Morocco 24.98% 22.64% 27.24% 2014
Palestine 16.14% 14.92% 17.06% 2007
Yemen 15.42% 13.15% 17.58% 2015
Bahrain 14.10% 14.13% 14.06% 2010
Oman 12.63% 11.91% 13.37% 2010
Jordan 11.89% 10.41% 13.34% 2015
Iraq 10.30% 9.71% 10.83% 2013
Egypt 7.86% 7.42% 8.35% 2016
Saudi Arabia 6.89% 6.41% 7.36% 2016
Mauritania 4.48% 4.75% 4.21% 2013
Qatar 3.17% 2.28% 4.89% 2010
Table 6: Disability by Gender (Age 60 and Above)
Source: ESCWA (https://www.unescwa.org/sub-site/arab-disability-
statistics-2017
c- Sources of funding for health and coverage
The volume of health care expenditure reaches its peak at old age. However, many older persons are
either paying themselves or most plausibly remain without treatment if they cannot afford expenses.
The main source of health care funding in most Arab countries is individuals themselves. In fact, out-
of-pocket spending represents over 70% of total health expenditures in Yemen and Sudan (table 3).
In Mauritania, Syria, Morocco, and Egypt, individuals have to pay high health care costs directly (on
average 50% of total public health expenditures). In Iraq, Lebanon, and Tunisia, out-of-pocket
payments are also significant - they represent some 40% of total health expenditures.
18
In reality, out of pocket expenditures are higher than the above figures indicate, due to the informal
payments that families must pay to cover the cost of services, physicians, nurses, etc. Family remains
the main source for informal care as shall be discussed in chapter 3. Better data need to be collected
to properly measure the informal payments as well as that of informal family care.
Yemen 76.42
Sudan 75.52
Morocco 58.41
Egypt 55.66
Syria 53.69
Comoros 45.1
Mauritania 43.85
Iraq 39.73
Tunisia 37.73
Lebanon 36.42
Djibouti 35.8
Algeria 26.5
Libya 26.46
Bahrain 23.34
Jordan 20.87
United Arab Emirates 17.81
Saudi Arabia 14.31
Kuwait 12.74
Qatar 6.86
Oman 5.78
Table 3: Out-of-Pocket
Expenditure as a Percentage
of Total Health Expenditure
Source: World Bank
http://databank.worldbank.org/dat
a/reports.aspx?source=world-
development-indicators#
Due to limited public funding, it is unlikely to see any rapid improvement in health coverage in the
region in the immediate term. According to Lowe, in recent years public health programs in most
Arab countries saw a significant reduction in funding: the average per capita annual public health
expenditures in Arab countries are US$ 280 (purchasing power parities) which represent a third of
the amount spent by other countries in the world with the same average per capita income. During
the period 1995-2014, only a few countries have increased public health expenditures (annex 2).
The universality of health coverage remains limited according to available data. Tunisia and Palestine
have social health insurance systems financed by tax revenues and health insurance premiums. Only
the insured are entitled to free treatment. In Jordan and Iraq, only civil servants and military personnel
have free access to social health insurance. In Oman, Sudan, Syria, and Yemen, public health care is
19
free and accessible to all residents. In Bahrain, Qatar, Kuwait, Saudi Arabia, and the UAE, healthcare
services are financed by natural resource revenues and are exclusively reserved for citizens.
Expatriates must pay annual fees for access to national health care services. In Oman, all expatriates
in the private sector must be covered by their employer.
Algeria, Egypt, and Libya have public health care systems financed by tax revenues and insurance
premiums. Their systems cover both the insured and the uninsured.
The data required to analyze medical insurance coverage in old-age by gender was available for only
three countries: Egypt, Tunisia, and Jordan. The analysis shows that significant health coverage
disparities exist between men and women and between rural and urban women in all three countries.
Women are at a disadvantage compared to men, and urban women have better coverage than rural
women. In Egypt, Jordan, and Tunisia, rural women aged 60 and older are significantly less likely to
have health insurance (table 4) compared to men and women in urban areas. For the 50-59 age group,
medical insurance coverage concerns less than 30% in Egypt and 5% in Tunisia. In Jordan, around
30% are not covered.
Age
Medical insurance in primary job Urban Rural Urban Rural Urban Rural Urban Rural
Yes 61.66% 44.80% 23.66% 7,59% 81.94% 28.09% 30.56% 0.00%
No 38.34% 55.20% 76.34% 92,41% 18.06% 71.91% 69.44% 100.00%
Age
Medical insurance in primary job Urban Rural Urban Rural Urban Rural Urban Rural
Yes 37.33% 34.00% 19.23% 13.16% 45.71% 73.33% 33.33% 0.00%
No 62.67% 61.00% 81.00% 86.84% 54.29% 26.67% 66.67% 100.00%
Age
Medical insurance in primary job Urban Rural Urban Rural Urban Rural Urban Rural
Yes 51.00% 63.00% 43.48% 26.23% 45.45% 5.48% 0.00% 0.00%
No 49.00% 37.00% 56.52% 73.77% 54.55% 94.52% 100% 100%
50-59 60 + 50-59 60 +
60 + 50-59 60 +
TUNISIA
Male Female
Table 4: Incidence of Medical Insurance in Primary Job in Egypt, Jordan and Tunisia
Source: ERF, ELMPS 2012, JLMPS 2010, TLMPS, 2014
EGYPT
Male Female
50-59 60+ 50-59 60+
JORDAN
Male Female
50-59
20
d- National public policy and strategy for older persons
Some Arab countries have developed strategies and implemented public policy measures to improve
the situation of the elderly (table 7)37.
Table 1 - Existence of a national policy or strategy for older persons in Arab countries
Country Egypt Iraq Jordan Kuwait Oman Palestine Sudan Tunisia
National
policy or
strategy
for old
people
The Egyptian
constitution
2014
National
Strategy for
the
Prevention
and Control
of Non-
Communic
able
Diseases
Jordanian
National
Strategy for
Old People
(2008)
The five-year
plan 2016-2021
and national
senior health
care strategy for
old people.
Social Action
Strategy
(Ministry of
social
development)
and strategy
for the elderly
(ministry of
health)
National
Strategy for
the Elderly
in Palestine
2016-2020
National
Policy for the
Elderly 2009
National
Policy for
the Elderly
2016-2020
Table 7: Existence of a National Policy or Strategy for Older Persons in Arab Countries
Source: MIPAA. Based on the results of a questionnaire on the “Third Regional Review of the Madrid International Plan of
Action on Ageing, 2002” undertaken in ESCWA member countries in 2017. In Egypt, Palestine and Kuwait, public policy initiatives include the development of care centers and
health hubs that provide health, social and psychological support to older adults in need. Egypt has
also developed training programs in geriatrics and gerontology for physicians, nurses, and care
providers. Jordan has developed nursing homes (tax exempt) and daycare centers for the elderly. Syria
has set up several health care centers that provide geriatric care. These public initiatives are
supplemented by civil society initiatives. The degree to which civil society participates in elder health
care is decisive in many countries. Egypt, Bahrain, Morocco, Palestine, and Tunisia, have developed
home-based services such as mobile health units that provide care to older adults in their homes. In
Lebanon, civil society, the Alzheimer Association, and SANAD, a home hospice association
established in 2009, play an important role in caring for the elderly.
The vast majority of developed countries have universal coverage through their primary insurance
programs. It is only by developing universal health coverage systems that Arab countries will be able
to reduce the financial hardship caused by health spending.
3. Education and employment
a. Education
Elder literacy remains a persistent challenge in the region. A higher level of education is generally
associated with a better health status and reduces the vulnerability of the elderly (Schröder-Butterfill,
E. & Marianti, R., 2006). Because they can adapt more easily to changes in the labor market, it follows
that older people who are more educated have better job opportunities. Moreover, education allows
access to better-paying jobs that require less physical work, which is an important criterion as people
age and their physical capacities decline.
The following figure shows that secondary educational attainment is under 18% for Arab countries
whereas higher educational attainment does not exceed 13.8%. The situation varies tremendously
from one Arab country to another. Gulf countries have the highest education rates both for secondary
and higher education in contrast to North African countries that have the lowest.
37 For more on Arab governments’ policies and programs on ageing, see Ageing In The Arab Region: Trends,
Implications And Policy Options. ESCWA UNFPA CS 2014. Available at :
http://www.csa.org.lb/cms/assets/csa%20publications/unfpa%20escwa%20regional%20ageing%20overview_full_reduc
ed.pdf
21
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
Lebanon
Oman
Qatar
UAE
Bahrain
Kuwait
Jordan
Saudi Arabia
Egypt
Syrian Arab Republic
Libya
Tunisia
Morocco
Iraq
State of Palestine
Algeria
Sudan
Mauritania
Yemen
Figure 5: Educational Attainment in Secondary and Higher Education Levels for Ages 60+
Educational Attainment (Higher, Age Group:60+) Educational Attainment (Secondary, Age Group:60+)
Source: Barro and Lee database (http://barrolee.com) - Year: 2010 except for Palestine, Oman,
and Lebanon. Palestine - 2011 (PCBS) / Oman and Lebanon: completed secondary or higher
education from Gallup 2011 survey.
Women continue to have higher illiteracy rates compared to men in many of the Arab countries, and
this is particularly true for women living in rural areas. In Egypt, Jordan, and Tunisia, where data by
gender is available, the illiteracy rate approaches 100% (table 8).
22
Age
Education Urban Rural Urban Rural Urban Rural Urban Rural
Illiterate 20.2% 48.0% 25.1% 66.7% 42.5% 85.9% 58.9% 92.6%
Reads & Writes 6.7% 9.3% 11.2% 10.7% 6.0% 3.0% 5.7% 2.5%
Elementary School 20.4% 14.3% 17.7% 12.8% 16.1% 4.7% 15.4% 4.2%
Secondary education 23.3% 17.2% 18.9% 4.9% 19.6% 4.6% 10.2% 0.6%
Post-secondary 5.6% 1.7% 3.7% 0.6% 2.4% 0.7% 1.5% 0.0%
University 21.4% 9.4% 21.5% 3.1% 12.8% 1.1% 7.7% 0.1%
Post-Graduate 2.4% 0.1% 1.9% 0.0% 0.7% 0.6% 0.0%
Age
Education Urban Rural Urban Rural Urban Rural Urban Rural
Illiterate 5.8% 17.9% 23.6% 41.1% 28.0% 50.9% 67.2% 96.1%
Reads & Writes 25.4% 34.5% 30.4% 37.2% 24.2% 31.1% 15.5% 4.9%
Elementary School 22.4% 16.1% 14.0% 11.1% 18.7% 8.5% 7.2% 1.0%
Secondary education 15.3% 13.1% 10.8% 5.8% 11.4% 1.7% 5.4% 1.0%
Post-secondary 10.2% 6.6% 4.3% 1.0% 11.6% 7.3% 2.6% 1.5%
University 16.6% 11.3% 11.2% 2.9% 5.3% 0.6% 1.4% 0.0%
Post-Graduate 4.4% 0.6% 5.7% 1.0% 0.8% 0.0% 0.7% 0.0%
Age
Education Urban Rural Urban Rural Urban Rural Urban Rural
Illiterate 14.0% 31.0% 52.0% 83.0% 43.0% 81.0% 81.0% 97.0%
Reads & Writes 34.0% 38.0% 17.0% 10.0% 29.0% 13.0% 8.0% 1.0%
Elementary School 20.0% 17.0% 8.0% 3.0% 13.0% 4.0% 3.0% 1.0%
Middle school 13.0% 8.0% 8.0% 2.0% 5.0% 2.0% 5.0% 0.0%
Secondary education 12.0% 6.0% 9.0% 2.0% 6.0% 0.0% 2.0% 0.0%
Post-secondary 2.0% 0.0% 2.0% 0.0% 2.0% 0.0% 0.0% 0.0%
University 3.0% 1.0% 2.0% 0.0% 2.0% 0.0% 1.0% 0.0%
Post-Graduate 0.0% 0.0% 1.0% 0.0% 0.0% 0.0% 0% 0%
TUNISIA
Male Female
50-59 60 + 50-59 60 +
Table 8: Older Persons' Educational Level in Egypt, Jordan and Tunisia
Source: ERF, ELMPS 2012, JLMPS 2010, TLMPS, 2014
EGYPT
Male Female
50-59 60+ 50-59 60+
JORDAN
Male Female
50-59 60 + 50-59 60 +
Most Arab countries have taken some measures to combat illiteracy among the elderly (table 9).
Tunisia, Jordan, Lebanon, Egypt, Sudan, and Morocco have integrated strategies to eradicate
illiteracy and educate the elderly without literacy competencies at the national policy level. Tunisia
implemented a national strategy to eradicate illiteracy and educate the elderly in 2016. Sudan has
developed evening classes for the elderly in schools. Morocco, has introduced literacy programs in
mosques, and in Egypt, the government introduced a literacy program for older people. Palestine and
Iraq have not developed specific elder literacy programs.
23
Country Egypt Iraq Jordan Kuwait Lebanon Morocco Oman Palestine Sudan Tunisia
Literacy
programs
Literacy and
education
program for
older people
under the
ministry of
higher
education
Nothing
specific for
the elderly
National
Strategy
under the
Ministry of
Education
and The Adult
literacy and
education
system (#81)
2005
Part of the
policy of the
ministry of
education to
eradicate
illiteracy
Elder
educational
program
under the
ministry of
social affairs
Literacy
programs in
mosques, on
television, and
on the
internet
Part of the
education
policy set by
the ministry of
education
Nothing
specific for
the elderly
Evening
classes for
the elderly
available in all
areas and
schools
National
Strategy to
eradicate
illiteracy and
educate the
elderly 2016-
2028
Source: MIPAA. Based on the results of a questionnaire on the “Third Regional Review of the Madrid International Plan of Action on Ageing, 2002” undertaken in
ESCWA member countries in 2017.
Table 9: Literacy Programs in Arab Countries
b. Work Status
Work is a source of social connection and financial well-being for the elderly and it contributes to
reducing vulnerability to dependency and poverty. To compensate for the absence of social insurance
programs, individuals tend to work longer. In fact, as figure 6 demonstrates below, a large percentage
of older Arab men continue to work after the legal retirement age. However, Almost two-thirds of
workers in the region work in the informal sector with no access to health insurance and are not
contributing to a pension system.
In Arab countries, women are more vulnerable due to their limited access to the labor market. As
previously shown (Table 1), in Tunisia, Jordan, and Egypt (countries for which data by gender is
available), around 80% of women are excluded from the labor market. At old-age, on average merely
5.2% of women work compared to 22% for both sexes combined (figure 8). In Comoros, where life
expectancy is very low compared to other countries in the region (65 years at birth for women and 62
for men), women aged 60+ have the highest employment rate (21%) while in this country 30% of
women are in the workforce.
In Bahrain and Qatar, 10% of older women are still active. For other Arab countries, the elderly
employment rate for women is under 6 %.The difference of the employment rate among women goes
along with the statutory retirement age. In the surveyed countries, men and women retire at the same
age with the exception of Jordan and Kuwait (table10).
Some countries have implemented specific programs to support the elderly poor. Algeria, for
example, has implemented cash transfer programs to support those unable to work due to old age
(Abu Ismail, 2015)..
24
0
0.1
0.2
0.3
0.4
0.5
0.6
Algeria Jordan Tunisia Palestine Oman Syria Iraq* Lebanon Egypt Yemen Saudi Arabia Morocco Bahrain Comoros Qatar
Figure 6: Employment Rate by Gender for Older Persons (60+) in Arab Countries
Both Sexes Females
Source : ILO (http://ilo.org/ilostat/faces/home/statisticaldata) - Most recent value. Algeria 2014,
Bahrain 2015, Comoros 2004, Egypt 2016, Iraq 2004, Jordan 2004, Kuwait 2016, Lebanon 2007,
Morocco 2012, Oman 2016, Palestine 2015, Qatar 2013, Saudi Arabia 2015, Sudan N/A, Syria 2009,
Tunisia 2012, United Arab Emirates 2016, Yemen 2014. Libya N/A, Mauritania N/A, Djibouti N/A
Somalia N/A
Egypt Iraq Jordan Kuwait Lebanon Morocco Oman Palestine Sudan Tunisia
60+ 63+ 60+ 65+ 64+ 60+ 60+ 60+ 65+ 60+
Male 60 63 60 52 64 63 60 60 65 60
Female 60 63 55 47 64 63 60 60 65 60
Male N/A 60 60 55 64 60 60 60 65 60
Female N/A 55 55 50 64 60 55 60 65 60
Retirement
Age (Public
Sector)
Retirement
Age (Private
Sector)
Source: Based on the results of a questionnaire on the “Third Regional Review of the Madrid International Plan of Action on Ageing, 2002”
undertaken in ESCWA member countries in 2017.
Table 10: Legal Retirement Age in Arab Countries
Country
Old age
4. Enabling environment
a- Social connectedness
Maintaining the solid social connections and family ties that constitute a key financial and social
resource is important in the Arab region and increasingly so with old age, especially in light of in
light of the weak social protection systems, limited pension and health coverage, and low educational
attainment rates. Literature shows that in all Arab countries larger social networks are often associated
with old age (Abdulrahim S. et al. 2015). Larger social connections can be more useful to the elderly
than any other resource as they have the potential to provide resources and care in later life (Sabbah,
I. et al. 2007). Gulf countries rank the highest in terms of social connections of older persons (all over
25
80%) (figure 7)38. The social connection for all ages is quite similar to the old-age. The difference is
highest is Yemen (57 % for old-age against 70 % for all ages).
QA KU SAU
BA JO SU UAE MAU AL SOM
DJI MO EGLI IR PA SY CO
TULE
YE
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Figure 7: Social and Family Connections for Ages 60+ in Arab Countries (%)
60+ Years Old All Ages
Source: Gallup (see Annex for the survey methodology).
b- Living conditions and housing arrangement for older persons
In Arab countries, beyond being a source of social relations, the family as a social institution is the
most well-established provider and care-giver to the elderly. Literature on this topic highlights that in
Arab countries it is quite common for the elderly to live in multigenerational households where the
family is the main care-giver and financial provider. This has led to pensions built around family
kinship (Yount et al., 2009, Sinunu et al. 2009).
Data available for Arab countries indicate that a great majority of older persons presently live with
their families. In Lebanon, the proportion of those who live in nursing homes does not exceed 1.3 per
cent, and it is less than 0.005 per cent in the other Arab countries.39 For different reasons, including
the availability of such institutions, the Inquality of services they provide, as well as to structure of
Arab families, these proportions remain far different from those recorded in western countries.40 For
example, the percent of older persons living in institutions was 6.5 per cent in France in 1994; 5.5 per
cent in Netherlands in 1995; and 11.6 per cent in Canada in 200841).
38 Social/family connections is measured according to the share of people aged 60+ who replied “yes” to the Gallup
survey question: “If you were in trouble, do you have relatives or friends you can count on to help you whenever you
need them, or not?” 39 Ageing in the Arab region: Trends, Implications and Policy Options (CSA, ESCWA and UNFPA) 40 Jacobzone,S & Cambois , E. and Robine, J.M. « la santé des personnes âgées dans les pays de l’OCDE s’améliore-t-
elle assez vite pour compenser le vieillissement de la population ? » Revue économique de l’OCDE n° 30, 2000/I
https://www.oecd.org/fr/eco/croissance/2732562.pdf 41 Institut national de santé publique du québec (2010) Vieillissement de la population, état fonctionnel des personnes
âgées et besoins futurs en soins de longue durée au Québec,
https://www.inspq.qc.ca/pdf/publications/1082_VieillissementPop.pdf
26
Household size can provide a broad indication about the residential situation of older persons. The
decline in household size is often cited as cause for alarm in planning for elder care. However, table
12 shows that, generally, Arab households have a large size, which seems to suggest that the fertility
transition has not significantly affected household size after all.42 In fact, in most Arab countries, the
number of persons per household decreased only slightly from 1990 to 2012, suggesting that the older
persons in the region have still usually been living in large households.
According to recent data from Morocco,43 by 2015, two-thirds of persons 60 years or older live in
households of four or more members, and this is true for a higher proportion for males than females:
71.1 per cent compared with 62.5 per cent. However, this proportion is indeed gradually declining
since it was recorded at about 74.7 per cent in 2004. This slight downward trend is consistent across
the region, as a recent study by ESCWA showed a general decline in average household size over the
period 1990-2012. “Over the last 20 years, the general trend across the region has been a steady
decline in average household size from around 6-7 persons per household to approximately 5 persons
per household.”44 Some countries are outliers, however, with data showing that household size in
Bahrain, Mauritania, Sudan and UAE has fluctuated or even slightly increased over the same time
period.
42 In Mauritania and Yemen household size has remained constant or increased. 43 ONDH (2017) “Situation, prospective, institutional and politics on ageing in Morocco”. Forthcoming. 44 ESCWA. (2015) A Compendium of social statistics. Issue No. 12
27
Country Around 1990a Around 2000 Around 2012
Algeria 7.0 (1992) 6.51 / 6.3 (2002**) 5.9 (2008i)
Bahrain 7.0 (1989) 5.95 6.37
Egypt 5.3 (1991) 5.19 4.35
Iraq* 7.7 (2002)
Jordan* 6.0 (1997k) 4.8 (2015)
Kuwait 8.8 (1987) 7.59 8.36
Lebanon 4.9 (1996) 4.6 4.4 (2011m) / 4.16
Libye 6.1 (2007 d)
Mauritania 5.2 (1990) 6.0 (2001g) / 6.2 (2013f)
Morocco 5.8 (1994b) 5.2 (2004b) 4.6 (2014b)
Oman 6.3 (1989) / 8,4 (1995c)
Qatar 6.7 (1987) 5.36 5.33
Saudi Arabia 7.4 (1987) 6.08 5.8 (2010+) / 5.79
Sudan * 5.1 (1993l) 5.8 (2002) 5.7 (2008*+)
Syria* 5.1 (1994h) 4.4 (2004h) 4.1 (2010m)
Tunisia 5.4 (1995) 5.48 3.9 (2014++)
UAE 7.4 (1987) 5.25 6.3 (2016*)
Yemen 6.7 (1991) 6.7 (2002)
Table 8 : Average Households Size in Some Arab Countries.
Sources:
Elswhere: https://www.nakono.com/tekcarta/databank/households-average-household-size/
*+ http://cbs.gov.sd/files/S%20in%20F%202008-2012.pdf
++ RGPH 2014 f RGPH2013 http://www.ons.mr/images/RGPH2013/Chapitre10_Chefs_m%C3%A9nages_fr.pdf
** http://www.sante.gov.dz/images/population/RAPPORT%20FINAL%20PAPFAM.pdf
+ http://data.un.org/Data.aspx?d=POP&f=tableCode%3a327
* http://www.arcgis.com/home/item.html?id=bb9bf7c53c274d19b369901a3cbde406
(m) Palestinian Central Bureau of Statistics http://www.pcbs.gov.ps/post.aspx?lang=en&ItemID=1823
(l) 2011 المجلس القومي للسكان ، تحليل أوضاع سكان السودان: الراهن، المآلات و الافاق
(b) HCP RGPH 1994 , RGPH 2004 et RGPH2014
(a) النتائج المجمعة للمسح العربي لصخة الأم والطفل في الوطن العربي )2001( ، وحدة الدراسات والمسوحات الميدانية الإجتماعية، الجامعة العربية
(k) Department of Statistics (1998) Family Health Survey 1997
(i) ONS (Algérie) MICS 2008 (Rapport principal)
(h) الهيئة السورية لشوؤن الأسرة )2008( حالة سكان سورية
(g) ONS (Mauritanie) et ORCMacro2001, DHS 2000-01
(d) 2007 الجامعة العربية)2008( المسح الوطني اللبي لصحة الأسرة
(c) Oman Family Health Survey 1995 (GFHS)
In countries like Morocco and the State of Palestine ‒ which, as we have seen, are in different stages
of their fertility transition- ‒ two-thirds of the households are nuclear while non-nuclear households
represent less than one third (annexes 11 and 12). In addition, over time, there is a trend of increasing
nuclearization, which is evidence of declining cohabitation. In particular, the proportion of older
persons who live with relatives may be decreasing. In other countries, the same pattern is observed.
In Bahrain, Jordan and Qatar, “more than two-thirds of households consist of nuclear families while
around 20 per cent of households in these countries show extended family living arrangements.”45
45 ESCWA. (2015) A Compendium of social statistics. Issue No. 12
28
Another indicator of the residential family structure is the percentage of older people living alone.
This indicator is usually used for understanding implications for the vulnerability of older persons.
Table 14 shows that the prevalence of older persons living alone is not high in Egypt, Jordan, Kuwait,
Sudan and Morocco, while it is relatively higher in Lebanon, Oman and the State of Palestine.
Scholars argue that “relatively high rates of emigration among youth may contribute to the higher
rates of living alone by older adults in Lebanon compared with other Arab countries. Older adults of
higher socioeconomic status are also more likely to live alone than those of lower status.”46 These
proportions are low in comparison with the prevalence of older persons living alone in OECD
countries, where proportions vary from 20 per cent to more than 50 per cent.47
Countries Lebanon Egypt Jordan Kuwait Sudan
Age 65+ 65+ 65+ 65+ 65+ 60+ 65+ 60+ 65+ 60+ 60+
Years 2006 2014
Males 7% 7,2 8,0 2,0 2,4 3,4
Females 18% 39,8 46,7 41,0 45,4 9,9
Both Sexes 12% 5% 7% 1% 2% 11,6 13,4 13,7 11,4 6,8 5,4
Table 9: Proportion of Old Persons Living Alone by Sex of Head of Household
Tohme R. A., Yount K. M., Yassine S., Shideed O., Sibai A. M. (2011). Socioeconomic resources and living arrangements of older adults in Lebanon: who
chooses to live alone? Ageing and Society, 31, 1–17. 10.1017/S0144686X10000590
Ajrouch K. J., Yount K., Sibai A. M., Roman P. (2013) A gendered perspective on well-being in later life: Algeria, Lebanon, and Palestine. In McDaniel S.,
Zimmer Z., editors. )Eds.(, Global Ageing in the 21st Century )pp.49–77(. Surrey, UK: Ashgate Publishing.
For Morocco: HCP, RGPH 2014 www.hcp.ma
For State of Palestine and Oman: https://unstats.un.org/unsd/demographic/products/dyb/dyb_Household/dyb_household.htm
Sources:
Oman State of Palestine Morocco
2003 1997
Table 9 also shows that more elderly women live alone than men, which is partially the result of
widowhood. As table 11 shows, half or more of the older women in Egypt, Jordan and Tunisia were
widowed. Widowhood increases women's vulnerability, particularly as women are often poorly
educated and are rarely financially independent (due to the low participation rate of women in the
labor market in Arab countries). In countries undergoing conflict, including Syria and Yemen, the
majority of female headed households are run by widows (Abu-Ismail, 2015).
46 Abdulrahim, S. Ajrouch, K. J. and Antonucci, T.C. “Ageing in Lebanon: Challenges and Opportunities”
Gerontologist. 2015 Aug; 55(4): 511–518. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542589/
(Sibai et al., 2009; Tohme et al., 2011) 47 Eurostat.
29
Age
Marital Status Urban Rural Urban Rural Urban Rural Urban Rural
Single 2.5% 0.4% 1.0% 0.1% 2.7% 1.3% 2.0% 1.1%
Married 93.7% 98.0% 85.2% 88.6% 69.6% 69.4% 37.3% 35.1%
Divorced 1.6% 0.5% 1.3% 0.2% 3.3% 2.5% 1.9% 2.4%
Widowed 2.1% 1.2% 12.6% 11.0% 24.4% 26.8% 58.7% 61.4%
Age
Marital Status Urban Rural Urban Rural Urban Rural Urban Rural
Single 1.5% 0.6% 0.9% 1.0% 4.4% 6.8% 2.3% 1.5%
Married 96.9% 98.8% 91.1% 93.7% 73.9% 75.1% 44.5% 54.9%
Divorced 1.3% 0.0% 0.7% 1.0% 2.5% 0.6% 2.3% 0.5%
Widowed 0.2% 0.6% 7.3% 4.3% 19.2% 17.5% 51.0% 43.2%
Age
Marital Status Urban Rural Urban Rural Urban Rural Urban Rural
Single 2.2% 1.8% 1.3% 0.7% 6.0% 7.4% 1.8% 1.1%
Married 95.1% 97.1% 88.5% 91.0% 82.6% 82.4% 50.5% 61.6%
Divorced 1.5% 0.7% 0.9% 0.8% 2.6% 0.8% 2.0% 0.9%
Widowed 1.2% 0.5% 9.2% 7.6% 8.9% 9.4% 45.7% 36.4%
Table 11: Senior Marital Status in Egypt, Jordan and Tunisia
Source: ERF, ELMPS 2012, JLMPS 2010, TLMPS, 2014
EGYPT
Male Female
50-59 60+ 50-59 60+
JORDAN
Male Female
50-59 60 + 50-59 60 +
TUNISIA
Male Female
50-59 60 + 50-59 60 +
Living arrangements of older persons is particularly important for the those who are dependent for
the ordinary activities of daily living (ADLs). Activities of daily living (ADLs) include personal-care
activities such as eating, bathing, dressing, and using the toilet. Women are more vulnerable given
that more women than men are ADL dependent in almost all of the selected Arab countries. Figure
16 shows the proportion of older persons who are ADL dependent in selected Arab countries. Tunisia
has the highest percentage of dependent older adults: 46.8% for women and 32% for men. Lebanon
also exhibits a high rate of dependent women with (31.2%), while only 18.5% of men are ADL
dependent. Egypt and Jordan follow with 28% of women ADL dependent, and 22.4% and 27.1% of
men respectively. In the case of Jordan and Iraq, we see that men are slightly more dependent than
women, but the overall percentage of dependent population remains lower than in other countries
(only 17% of women in the UAE and 14.2% in Iraq vs. 22% of men in the UAE and 17% in Iraq).
30
0
10
20
30
40
50
60
70
80
90
Algeria Egypt Iraq Jordan Lebanon Morocco Saudi
Arabia
Tunisia UAE
Figure 12: Prevalence of ADL Dependence (Disability for Activities of Daily Living) in Selected Arab
Countries (%)
Men Women
Source: Yount and Sibai, (2009), Peter Uhlenberg, “International Handbook of Population Ageing”
(2009), Chapter 13, Volume 1, Springer Science-Business Media B.V. pp. 227-315. Table 13.14,
p.305. Kouaouei A., Projet Pan Arabe pour la Santé de la Famille, 2005. Enquête nationale sur les
personnes âgées au Maroc, (2006), Rapport d’enquête, Royaume du Maroc – Haut-Commissariat au
Plan. General Authority for Statistics, Kingdom of Saudi Arabia, https://www.stats.gov.sa.
As the population ages in the region, diseases and the proportion of dependent elderly for activities
of daily living also increase, in particular among women. As we have seen, their situation is very
problematic in a number of countries where women are less likely to qualify for old-age pension
benefits and for health insurance.
The Impact of Crisis on Older Persons in the Region: A Focus on Syria
Several countries in the Arab region are currently experiencing armed conflicts including
Syria, Yemen and Libya. The direct and indirect effects of conflict on neighboring
countries, other countries in the region, and beyond are well-known and evidenced by
research. Conflict diminishes financial resources, reduces and displaces populations,
increases morbidity and mortality, weakens social networks and cohesion, and has an
impact on people’s psychological wellbeing.
While research and programming has often focused on the impact of conflict on particularly
vulnerable groups including women and youth, there is urgent need for better understanding
of the consequences for other already vulnerable populations, such as older and disabled
persons. These members of society are disproportionately affected through weakening of
social ties and loss of family members from whom they received support; loss of economic
resources; deterioration of health and psychological conditions; and restricted access to
humanitarian aid. Although older persons are a growing share of the population in many
countries, they are often overlooked in aid and humanitarian efforts; their specific needs are
not researched, consulted nor taken into account, and few projects target them specifically
as a vulnerable group. Additionally, older persons, especially older women, have a higher
risk of abuse and neglect (HelpAge International, 2016).
31
In Syria and Libya, older persons represented around 6.4 and 6.5 per cent of the population,
respectively, in 2015. In Yemen, older persons represented 4.5 per cent. Regardless of the
size of the older population, the needs of older persons must not be neglected, as this case
study shows, they suffer disproportionately from conflict but also play a key role in
supporting the survival and success of their younger family members.
The Impact of the Syrian Conflict on Older Persons
Since 2011, Syria has faced an intractable conflict that emerged from a deep socio-political
crisis. The continuation of this conflict reveals its complexity within certain political,
economic, and social dimensions. The impact of the crisis has been devastating, and the
country is rapidly losing its human, physical, financial, social, and natural assets and
potential. The conflict has impacted all Syrians across different regions, genders, and age
groups. Many individuals from vulnerable groups, including older persons, who suffered
from exclusion even before the crisis have now also lost their sources of living and
protection, and have suffered from physical, social, and economic burdens to become
among the overlooked victims in Syria.
Understanding the impact and dynamics of the crisis in Syria is important in order to
identify strategies, policies, and programs that promote inclusion and further understanding
of how the conflict has affected older persons in Syria. Older persons have faced a variety
of situations within the war, including those who have stayed in their homes, those who are
internally displaced, refugees who have fled the country, and those who migrated outside of
Syria for other reasons. It is important to consider the immediate, medium, and long-term
impacts of the crisis on the older population and there is more research needed on this topic.
This section highlights the major challenges faced by the elderly during conflict and
difficult humanitarian conditions, based on existing analysis and reports about the impact of
Syrian crisis.
Before the crisis, Syria had social protection systems in place, including broad health care
coverage, but implementation and availability of services were still inadequate to meet the
needs of vulnerable groups including older persons. Limited accountability, inclusivity, and
transparency in institutions hindered the potential of the system to fully allow persons to
age in dignity (ANND, 2014). With the onset and expansion of conflict, older persons have
suffered increasing deterioration of economic and social conditions and further exclusion.
Older persons are encountering the following challenges as a result of the conflict:
• The loss of economic and financial resources, which strongly affects the capability of
older persons to function and interact within their communities (Hobfall, 2002). By the
end of 2015, the overall economic loss in Syria as a result of the conflict was estimated
at USD 254.7 billion, equivalent to 468% of the GDP of Syria in 2010 (SCPR, 2016a).
• Many older persons have lost their financial resources due to several reasons, including:
o The destruction of commercial and residential buildings, in which many
older persons had invested their lifetime savings. In Syria, as elsewhere in
the Arab region, owning a house at old age gave a sense of security.
However, as at 2015, at least 3 million buildings in Syria had been affected
by the war, and 1.2 million homes and 9,000 industrial facilities had been
destroyed (Al Jazeera, 2015).
o The loss of household breadwinners, including older persons’ sons and
daughters. The loss of adult children, upon whom many older persons
depended for economic, social, and other support, has diminished the
primary protection and support mechanism for older persons. This change is
32
reflected also by an increase in the old dependency ratio from 5.8 in 2010 to
7.0 in 2015 (Chapter 1, table 10).
o The loss of sources of livelihood, for themselves and/or of supporting
family members. 13.8 million Syrians have lost their work-related source of
livelihood, of which 9.5 million are still inside the country. Furthermore, at
the end of 2015, almost 2 million people, or 11.5 per cent of the population,
had been killed or injured, of which a significant proportion were working-
age male breadwinners (SCPR, 2016a).
o The deterioration in the living conditions. 48 per cent of internally
displaced Syrians were living in rented houses, creating further economic
burden as the additional expense takes a toll on savings, given the prolonged
nature of the conflict. Furthermore, there has also been a currency
devaluation and a surge in prices of all goods and services, which has also
created a drain on the savings of older persons to survive and to mitigate the
impact of the conflict on their daily lives.
• Increasing poverty. As a result of these economic difficulties, the overall poverty rate
in Syria had risen to 85 per cent at the end of 2015, with around 70 per cent of the
population living in extreme poverty, meaning they cannot secure basic food and non-
food items necessary for survival. The percentage of the population living in abject
poverty, meaning they cannot meet even basic food needs, increased dramatically from
just 0.07 per cent in 2010 to 35 per cent in 2015 (SCPR, 2016a). As for Syrian refugees,
70 per cent of those living in Jordan and Lebanon are considered to be poor (Verme et
al., 2016).
• Mortality. Syrian older persons have been tremendously affected by the number of
fatalities during the crisis. The Syrian crisis has led to the death of about half a million
people, the majority of which are male youth (SCPR, 2016b). The loss of family
members is expected to have a large impact on older persons in terms of
intergenerational relations, loneliness, loss of social support and hope for the future
(Moss et al., 1987). Moreover, the armed conflict has produced around two million
injuries among the Syrian population, a fact that might have increased the burden on
many elderly people in supporting their injured family members.
• Disability, disease, and depression. In addition to facing the challenges of lack of
income, appropriate shelter and essential household items, studies have shown that 77
per cent of older Syrian refugees in Lebanon and Jordan live with impairment, injury, or
chronic disease. Within the population of older Syrian refugees, 54 per cent have a
chronic disease, 66 per cent have an impairment, and 33 per cent have a severe
impairment. Additionally, 60 per cent have problems in daily living activities (HelpAge
International, 2014). Moreover, older Syrian refugees often face depression and
cognitive deficits and express concerns about illness, loneliness, and instability (Chemali
et al., 2017). Studies have shown that 65 per cent of older Syrian refugees present signs
of psychological distress, a rate three times higher than the general refugee population
(HelpAge International, 2014).
• Reduced health services. The crisis has severely affected the population’s ability to
access health facilities, particularly in conflict zones, due to insecure conditions and the
destruction of health infrastructure. Readiness and efficiency were catastrophically
affected by the loss of human capital, reduction in health resources and expenditure,
loss of equipment and medicine, and difficulties in importing the necessary health care
33
materials and supplies (WHO, 2015). In 2015, 57 per cent of the hospitals in Syria had
been damaged, 36 per cent had been destroyed, and at least 50 per cent of physicians had
fled the country (AlJazeera, 2015). This represents yet another burden on older persons
who have particular need to access effective health services, often due to common
chronic and ageing-associated disease, as well as conflict-related health issues, such as
traumatic injury and disability. It is worth noting that the impact on availability and
quality of health care for older persons as a result of the indirect and lingering effects of
the conflict has almost been equal to the effects of direct conflict (Ghobarah et al.,
2003).
• Poor living conditions for refugees: a study shows that in addition to the lack of
income, appropriate shelter, and essential house items, about 75% of elder Syrian
refugees in Lebanon and Jordan live with impairment, injury, and chronic disease
(HelpAge International, 2014). Moreover, elder Syrian refugees face depression and
cognitive deficits and express concerns about illness, loneliness, and instability (Chemali
et al., 2017).
• Forced displacement inside and outside of Syria has increased the immediate burden on
older persons. About half of the Syrian population has left their homes. At the end of
2015, 6.3 million people, or around 60 per cent of the displaced population were
internally displaced; 3 million, or around 29 per cent, were refugees; and over 1 million,
11 per cent of the population, were international migrants (SCPR, 2016a). Calculations
estimate that older people account for almost 5% of the Syrian refugee population, of
which an estimated 3% are registered with UNHCR. The lower registration rate can be
partly explained by the fact that older people have heightened challenges to reach
registration points (HelpAge International, 2014). Older persons’ disabilities or mobility
difficulties may have contributed to fewer leaving their residences in conflict zones.
• Long-Term Psychological Effects of Displacement. Displacement is expected to have
even further impacts on the population of older persons in the future, considering that
the average length of forced displacement is 20 years for refugees and more than 10
years for internally displaced persons (European Commission, 2017). This means that
today’s working-aged displaced persons will be tomorrow’s elderly displaced population
and will likely suffer high levels of anxiety and low levels of resilience and life
satisfaction in the future, as demonstrated by other older persons in protracted
displacement situations (Kuwert et al., 2009).
• Declining social capital. Many studies show that social capital has positive effects on
behavior and health patterns, especially for older persons when compared to their
younger counterparts (Muckenhuber et al. 2012, Nilson et al., 2006). Social capital is a
concept that describes an individual, group or population’s economic and cultural capital
which forms social networks and transactions marked by reciprocity, trust, and
cooperation and a sense of working towards a common good. Social capital is often
damaged in situations of conflict, as networks break down, communities are fractured,
and services and transactions are interrupted. In Syria, the social capital index has
declined by 30 per cent during the crisis compared to the pre-crisis period. This decrease
is a result of notable declines in the three components of the index, albeit to varying
degrees. The decline in social trust contributed to the overall decline by 58 per cent,
whereas the contributions of values and networks were at the rates of 22 per cent and 20
per cent, respectively (SCPR, 2017). The continuing deterioration of social capital will
also have medium and long-term effects on the older population, as studies of resilience
34
and vulnerability of older persons in the aftermath of conflict have shown(Kimhi et al.,
2012).
The negative impact of the crisis in Syria on older persons has been significant and has
affected older persons’ health, psychological, social, and economic wellbeing. The conflict
has had an immediate impact on the current older population, and according to research on
other post-conflict situations, is likely to impact the next generation of older persons. Thus,
there is a need for short-term policies within a strategic vision in which the rights and
dignity of all population groups, including older persons, are protected and respected.
Moreover, it is important to recognize that Syria’s older persons could play a major role in
rebuilding social cohesion after the conflict has ended, contributing their experience to
support an inclusive reconstruction process.
There is a gap in understanding elderly needs and identifying related policies and projects
compared to attention given to women and children although old persons are more
vulnerable due to health and marginalization challenges (WHO, 2008). Thus, first there is a
need to analyze thoroughly the impact of the conflict in Syria on elderly people to have a
scientific base on which a related strategy and policies could be formulated as part of a
comprehensive plan to overcome the crisis. Meanwhile, immediate programs should be
implemented to mitigate the conflict effects on elderly; these programs include ensuring
availability and accessibility of health and humanitarian services for them, providing
psychological and social support, designing an economic support programs for old persons
to have better living conditions, and including them as an essential part in the
reconciliation, reconstruction, and development processes.
Conclusion and policy implications
Ageing can pose challenges to development, however if measures are taken to anticipate the
demographic transition, it can also offer opportunities. Sustainable development hinges on the
inclusion of all members of society including older persons. To this end, older persons require an
enabling environment that engages them in the different social and economic areas, empowers them,
and builds their resilience.
However, this chapter provided evidence of the alarming conditions of older persons in the Arab
region. Weak and non-inclusive social protection systems and limited pension and health coverage
leave large groups of older persons vulnerable to poverty and ill health. Older persons in LDC
countries, such as Yemen and Sudan, are at higher risk as findings show that less than ten percent
receive old age pension, while the out of pocket expenditure on health is the highest in the region. It
also showed that more than half of the older persons in Egypt and Iraq and the vast majority of them
in Sudan live in poverty.
Our findings also highlighted the vulnerability of older women in particular as they have higher rates
of illiteracy and very limited access to the formal labor market or pension coverage. Women are at a
higher risk of disability. The vast majority lack proper health coverage, and many do not have access
to adequate health facilities.
Elderly care in the region is predominantly the responsibility of the families in light of the weak social
protection systems. However, the structure of living arrangements of Arab families is changing from
extended households to a higher share of nuclear households due to a large number of reasons
including migration, urbanization, and changing personal preferences. This indicates that in the future
the ability and ways that families support older persons will change and possibly diminish. Therefore
there is an urgent need to develop other means to support older persons.
35
The case study form Syria helped to shed light on the harsh conditions of older persons in
humanitarian or crisis settings. Loss of family and economic resources and increased risk of disease
and injury, exacerbates older persons vulnerability to isolation and poverty.
Last but not least, this chapter highlighted the dearth of data that is disaggregated by age, sex, and
location. This data is necessary to better analyze the socio-economic conditions of older persons and
thus inform the policies that are needed to ameliorate their situation, and also preempt older persons
of the future from ageing in poverty.
Policy recommendations (to be moved to chapter 5)
To establish social security systems to protect people in old age from poverty and destitution
and to extend the social protection coverage, following the principles of universality of
coverage, non-discrimination and gender equality, (the ILO Social Protection Floor No. 202).
The Social Protection Floors Recommendation, 2012 (No. 202), emphasizes that in each
country, all residents and children should be guaranteed access to health care, prevention and
maternal care, financed through social protection systems and schemes.
To identify the gaps in the protection of the rights of older persons: gender discrimination in
old age; access to adequate health and care, and to create a policy environment capable of
addressing gender-based health care requirements.
To consider the value and the rights of the work performed by unpaid care-givers.
To address violence against older women, and recognize this is a global phenomenon
characterized by different forms of violence, on which data is currently not available. There
is a need for UN human rights mechanisms and agencies including UN Women and the
Commission on the Status of Women (CSW) to adequately address the issue of violence
against older women and to provide recommendations and develop benchmarks to inform and
measure progress within countries.
To raise awareness on the human rights of older persons and encourage engagement, including
for and with older persons themselves, their families, care givers, service providers, policy
makers as well as with international and regional human rights protection mechanisms.
To promote cooperation among various stakeholders and the important role of NGOs and
National Human Rights Institutions (NHRIs).
To develop binding instruments on older persons' human rights to promote and protect the
rights of older persons and to focus on implementation and monitoring of such legal
obligations, including through the development of national monitoring mechanisms and
implementation plans.
To collect data and to develop specialized national surveys on health status at old-age by
gender and according to residence (urban and rural).
To design a series of socio-economic indicators by age and gender to measure and compare
performance of social protection systems in the region.
36
Annexes
Source: WHO (Global Health Observatory Data Repository)
Life Expectancy at Birth by Gender in Arab Countries , 2015
Male Female
37
Note: Public health expenditure consists of recurrent and capital spending from government (central and local)
budgets, external borrowings and grants (including donations from international agencies and
nongovernmental organizations), and social (or compulsory) health insurance funds.
Source: World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database
for the most recent updates).
Age 50-59 Age 60+ Total 50+ Age 50-59 Age 60+ Total 50+ Age 50-59 Age60+ Total 50+
Female 52.8% 54.4% 53.6% 53.1% 50.3% 51.6% 50.9% 50.4% 50.6%
Male 47.2% 45.6% 46.4% 46.9% 49.7% 48.4% 49.0% 49.6% 49.4%
Urban 51.9% 52.0% 52.0% 73.9% 73.3% 73.6% 46.2% 42.7% 44.1%
Rural 48.1% 48.0% 48.0% 26.0% 26.7% 26.4% 53.8% 57.3% 55.9%
Total Number of Observations 3,606 3,909 7,515 1,322 1,549 2,871 1,763 2,728 4,491
Annex 3: Characteristics of the Elderly in Egypt, Jordan and Tunisia
Source: ELMPS 2012, JLMPS 2010, TLMPS, 2014
JordanEgypt Tunisia
Annex 2: Evolution of Public Health Expenditure for the Period 1995-2014 in the Arab Region
38
Annex 4
Gallup surveys methodology
Gallup Worldwide Research continually surveys residents in more than 150 countries, representing
more than 98% of the world’s adult population, using randomly selected, nationally representative
samples. Gallup typically surveys 1,000 individuals in each country, using a standard set of core
questions that has been translated into the major languages of the respective country. In some regions,
supplemental questions are asked in addition to the core questions. Major core questions are those on
income, education and employment. In addition to personal characteristics questions, other core
questions include, but are not limited to, questions on law and order, food and shelter, institutions and
infrastructure (community and national institutions, youth development, and corruption), jobs,
wellbeing (career, financial, physical, experiential and social wellbeing, civic engagement, life
evaluation, and experience), and community attachment (diversity, optimism, and religiosity.)
In the Arab region, up until the spring 2012 wave (wave 7.1), interviews were conducted face-to-face
and took approximately one hour to be completed. In most of the Arab countries, two waves were
conducted each year with the fieldwork of each generally completed in two to four weeks. All of the
22 Arab countries are covered in the Gallup World Poll Surveys between the years 2009 and 2012.
However, not all of them are covered in all the seven waves (see below in the definition of variables)
included in the data set available to Silatech. The 22 Arab countries are typically included in all waves
except for Oman (two waves), Djibouti (four waves), Libya (four waves) and Qatar (five waves).
In the Arab region, respondents are not necessarily nationals. However, any non-nationals
interviewed are of Arab nationalities. Therefore, there is no representation of non-Arab expatriates.
The number of survey questions can vary between countries and also between waves for the same
country. All the data includes responses from 142,365 individuals in all seven waves and all the 22
countries. The countries included and the response rate to individual questions can vary depending
on the number of waves the country is part of the survey, as well as answers like “do not know”,
“refuse” or simply omissions or wrong categorizations. For example, information on the respondent’s
age is practically complete (99.8%) while some variables of interest in the context of the current paper
are largely missing. For example, information on whether the respondent is working and, if so,
working for the government is available only in 53,334 cases (26,818 for men and 26,515 for women).
Moreover, some variables of interest such as working for the government and living in an urban/rural
area do not coincide in the same wave for most of the Arab countries.
39
2009 2013 1995 2004 2006
Total 100 100 100 100 100
One-person household 0.5 0.6 3.9 6.2 6.8
Nuclear household 68.8 77.7 59.9 62.6 34.9
Couple with children 63.7 - 48.3 49.5 21.7
Couple without children 2.1 - 3.5 4.8 6.9
Single parent with children 3.0 - 8.1 8.3 6.3
Non-nuclear household 30.7 20.7 36.2 31.2 58.4
A single family nucleus and other persons 0.4 - 2.1 - -
Two or more family nuclei 30.3 - 33.6 28.0 -
Others - - 0.5 3.2 -
Unkown - 0.9 - - -
Annex 11: Households in State of Palestine and Morocco by Type of Living Arrangement
* Only Old Persons Households
State of Palestine (1)
Sources: (1) https://unstats.un.org/unsd/demographic/products/dyb/dyb_Household/dyb_household.htm Excluding
data from the parts of Jerusalem which were annexed by Israel in 1967.
(2) HCP (2009) Les personnes âgées au Maroc: Profil, santé et rapports sociaux (Analyse des résultats de
l’Enquête nationale sur les personnes âgées )ENPA( 2006.
Type of household
Morocco (2)
Annex 12: Distribution of households by type of living arrangement, 1991-2014
Source: ESCWA. (2015) A Compendium of social statistics. Issue No. 12
40
References
Abdulrahim S., Ajrouch I.K. and Antonucci T.C., (2015) Aging in Lebanon: Challenges and
Opportunities, Gerontologist, Aug, 55(4): 511–518.
Al Hazzouri Z., Sibai M., Chaaya M, Mahfoud Z, Yount KM., (2011) Gender differences in physical
disability among older adults in underprivileged communities in Lebanon, J Aging Health, Mar,
23(2):367-82.
Abu-Ismail K., Abo Taleb G., Olmsted J. and Mohieddin M., (2015) The ADCR 2011: Employment,
Vulnerability, Social Protection and the Crisis of Arab Economic Reforms, Arab Development
Challenges, Background Paper 2011/05, United Nations Development Program.
HCP, (2006) Enquête nationale sur les personnes âgées au Maroc, Rapport d’enquête, Haut-
Commissariat au Plan, Royaume du Maroc.
HelpAge, (2013) Global AgeWatch Index methodology. HelpAge International.
Hussein S., Ismail M., (2017) Ageing and Elderly Care in the Arab Region: Policy Challenges and
Opportunities. In: Springer, Ageing International, pp 1-16.
https://link.springer.com/article/10.1007/s12126-016-9244-8 .
ILO (International Labour Office) (2009) “Growth, Employment and Decent Work in the Arab
Region”. Thematic paper, Arab Employment Forum. Beirut.
ILO (International Labour Office), (2014), World Social Protection Report 2014/15: Building
economic recovery, inclusive development and social justice International Labour Office – Geneva:
ILO, 2014.
Kouaouei A., (2005), « Enquête Algérienne sur la Santé de la Famille 2002 : Analyse
Approfondies » Projet Pan Arabe pour la Santé de la Famille.
Kronfol N.M., (2012) “Access and barriers to health care delivery in Arab countries: a review”,
Eastern Mediterranean Health Journal, Vol. 18 No. 12.
Marcus, R. and Pereznieto, P. (2011) Children and Social Protection in the Middle
East and North Africa: A Mapping Exercise, Working Paper 335, London: Overseas
Development Institute (ODI).
41
Palestinian Central Bureau of Statistics (PCBS) Website, Web. <http://www.pcbs.gov.ps>.
Palestinian Central Bureau of Statistics (PCBS), 2014. “Palestine in Figures 2014”, Ramallah –
Palestine.
Sabbah I, Vuitton DA, Droubi N, Sabbah S, Mercier M., (2007) Morbidity and associated factors in
rural and urban populations of South Lebanon: a cross-sectional community-based study of self-
reported health in 2000, Trop Med Int Health, Aug;12(8):907-19.
Schröder-Butterfill, E. & Marianti, R., (2006) A framework for understanding old-age vulnerabilities,
Ageing Soc., Jan; 26(1): 9–35.
Shah N, Yount K, Shah M, Menon I. (2002). Living arrangements of older women and men in
Kuwait. Journal of Cross-Cultural Gerontology, (17), pp. 337–355
Sinunu M, Yount KM, El Afify NAW. (2008) Informal and formal long-term care for frail older
adults in Cairo, Egypt: family caregiving decisions in a context of social change. Journal of Cross
Cultural Gerontology, 24(1), pp. 63–76.
Tzannatos Z. (2016) Effects of gender inequality in employment and pay in Jordan, Lebanon and the
Occupied Palestinian Territory: Three Questions Answered, August, ILO.
Tohme R. A., Yount K. M., Yassine S., Shideed O., Sibai A. M. (2011). Socioeconomic resources
and living arrangements of older adults in Lebanon: who chooses to live alone? Ageing and Society,
31, pp. 1-17.
Uhlenberg P. “International Handbook of Population Ageing” (2009), Chapter 13, Volume 1,
Springer Science-Business Media.
United Nations, (2015), World Population Prospects: the 2015 revision. Deparment of Economic and
Social Affairs, Population Division, 2015. World Population Ageing, 2015
Yount KM, Sibai AM. (2009) Demography of aging in Arab countries. In: Poston DL, Uhlenberg P.,
International handbook of population aging [electronic resource] Dordrecht: Springer Netherlands,
pp. 277–31.
References for Syria Case Study
Al Jazeera (March, 2015): “What’s left in Syria?”. Retrieved from:
http://www.aljazeera.com/indepth/interactive/2015/03/left-syria-150317133753354.html
42
Arab NGO Network for Development (2014): “Social Protection in the Arab World: the Crisis of
the State Exposed”, Arab Watch Report on Economic and Social Rights
Chemali Z., Borba C., Johnson K., Khair S., and G. Fricchione (2017): “Needs assessment with
elder Syrian refugees in Lebanon: Implications for services and interventions”, Global Public
Health Journal, 12 Sep, 1-13.
European Comission (2017): “Forced displacement: refugees, asylum-seekers and internally
displaced persons (IDPs)”. Retrieved from:
http://ec.europa.eu/echo/files/aid/countries/factsheets/thematic/refugees_en.pdf
Ghobarah H., Huth P., Russett B. (2003): “Civil Wars Kill and Maim People: Long After the
Shooting Stops”, American Political Science Review 97:2, 189-202
HelpAge International and Handicap International (2014): “Hidden Victims of the Syrian Vrisis:
disabled, injured and older refugees”
HelpAge International (2016): “Older Voices in Human Crises: Calling for Change”.
Hobfoll S. (2002): “Social and Psychological Resources and Adaptation”, Review of General
Psychology, 6:4, 307–324
Kimhi S., Hantman S., Goroshit M., Eshel Y., and L. Zysberg (2012): “Elderly People Coping With
the Aftermath of War: Resilience Versus Vulnerability”, The American Journal of Geriatric
Psychiatry, 20:5, 391-401
Kuwert P., Brahler E., Glaesmer H, Freyberger H., and O. Decker (2009): “Impact of Forced
Displacement during World War II on the Present-day Mental Health of the Elderly”, International
Psychogeriatrics, 21:4, 748–753
Moss M., Lesher E., and S. Moss (1987): “Impact of the Death of an Adult Child on Elderly
Parents: Some Observations”, Journal of Death and Dying, 17:3, 209-2018
Muckenhuber J., Strongger W., and W. Freidl (2012): “Social capital affects the health of older
people more strongly than that of younger people”, Aging & Society Journal, 33:5, 853-870
Nilsson J., Rana M., and Z. Kabir (2006): “Social Capital and Quality of Life in Old Age”, Journal
of Aging and Health, 18:3, 419-434
Syrian Center for Policy Research (2016a): “Confronting Fragmentation: Impact of Syrian Crisis”
Syrian Center for Policy Research (2016b): “Forced Dispersion: A Demographic Report on Human
Status in Syria”
Syrian Center for Policy Research (2017): “Social Degradation in Syria: The Conflict Impact on
Social Capital”
United Nations, Department of Economic and Social Affairs, Population Division (2015). World
Population Prospects: The 2015 Revision,.
43
United Nations High Commissioner for Refugees (2017): “Syria emergency”. Consulted on 27
October 2017. Retrieved: from http://www.unhcr.org/syria-emergency.html
Verme, Paolo, Chiara Gigliarano, Christina Wieser, Kerren Hedlund, Marc Petzoldt, and Marco
Santacroce. (2016): “The Welfare of Syrian Refugees: Evidence from Jordan and Lebanon”.
Washington, DC: World Bank. Retrieved from:
https://openknowledge.worldbank.org/bitstream/handle/10986/23228/9781464807701.pdf
World Bank, (2016): “Age dependency ratio, old, (% of working age population)”.
https://data.worldbank.org/indicator/SP.POP.DPND.OL?locations=SY&name_desc=false
World Health Organization (2008): “Older people in emergencies: Considerations for action and
policy development”, Geneva - Switzerland
World Health Organization (2015): “Developing health centers and hospitals indices for Syria”,
Damascus - Syria
44
CHAPTER 3
Two-Way Intergenerational Support
Lebanon as a Case Study
DRAFT – Not for Circulation
45
I. Introduction
Building on the previous two chapters, which describe the patterns and trends of population
ageing and government-provided social protection systems in the Arab region, this chapter takes an
in-depth look at the existing and changing social networks and support mechanisms that are often
the primary means of support for older persons in Arab countries. Though the family unit and
relationships are highly valued in the region, changes in the average family structure and on-going
conflicts and humanitarian crises in several countries of the region have had an impact on support
for older persons. This trend will continue if not recognized and addressed by States and societies.
In order to further inform discussions and policies about support for older persons, this
chapter specifically examines two-way intergenerational support that is already occurring in the
region. Two-way intergenerational support refers to support being provided both to and from older
persons. Understanding that older persons are not only vulnerable, receivers of support, but also
active contributors to the family and society after retirement is critical to grasp. The research
presented in this chapter demonstrates a case study where the centrality of the family is indeed the
most valued institution providing care, but is also becoming itself vulnerable to poverty and is
witnessing gender power developments that affect the dynamics of distributing care roles among its
members. On the other hand, this section also shows how younger generations may increasingly
rely on the monetary and non-monetary support of older persons. The evidence presented in this
chapter come from desk review of research and in-person interviews as a case study of older
persons in Beirut, Lebanon.
II. The Meaning of Family and Support for Older Persons in the Arab Region
In the Arab region, family is valued and regarded as the fundamental unit of support that
cannot be replaced by any institution (Sibai, Beydoun and Tohme, 2008; Tohme, Yount, Yassine,
Shideed & Sibai, 2010; Kronfol, Rizk & Sibai, 2015; Abdelmoneium & Alharahsheh, 2016).
Women, men, children, and older persons are all responsible in supporting and preserving the
family unit as a whole based on family codes, honor and unified central values (Nuha Abudabbeh,
1996; Sibai & Yamout, 2012). This family dynamic promotes the notion of intergenerational
support, which is the mutual exchange of resources and support among family members of different
generations (Abdulrahim, Ajrouch & Antonucci, 2012; Kronfol et al., 2015; Kagitcibasi, Ataca &
Diri, 2010).
These exchanges can take several forms including living arrangements as well as financial,
emotional, and instrumental support. Furthermore, researchers are interested in such exchanges
since they are a process for preserving bonds between generations (Allen, Blieszner, & Roberto,
2000). Intergenerational support plays a key role in providing resources to older family members
(Kronfol et al., 2015; Abdulrahim et al., 2012; Abdelmoneium & Alharahsheh, 2016). This is highly
valued, especially when there is a lack of societal or institutional support systems (Kagitcibasi et al.,
2010). These exchanges are regarded as filial and social obligations since children are expected to
reciprocate their parental investment with financial and social support when the children become
adults and their parents become older (Khan, 2014). Additionally, intergenerational exchanges are
even more prominent nowadays than in earlier times since older persons are living longer and can
share experiences with the youger generations (Sinunu, Yount & El Afify, 2009).
46
To gain a deeper understanding of intergenerational support in the Arab region, this
following sections will explore the various support exchanges between family members,
specifically among older adults and adult children.
A. Living Arrangements and Co-residence
In recent years there has been an increased interest in the living arrangements of Arab
families, in particular of older adults (Sibai et al., 2008; Tohme et al, 2010; Kronfol et al., 2015;
Shah, Yount, Shah and Menon. 2002). This is due to the fact that living arrangements are more
than just a physical housing, but rather a proxy for providing social and economic resources within
family members, promotes good health for older adults and a meeting place for the family (Sibai,
Baydoun & Tohme, 2008; Tohme et al, 2010; Kronfol et al., 2015; Shah et al. 2002; Lowenstein,
1999). Co-residence and living in close proximity to family are regarded as living arrangements
that promote intergenerational support and close family relationships (Aykan & Wolf, 2000; Yount,
2009; Shah, 2002; Sibai, Baydoun & Tohme, 2008). Kronfol et al. (2015) stated that, “co-residence
is one of the means by which Arab families fulfill the support owed to their older relatives (Kronfol
et al., 2015, p. 609). Trends of co-residence and living in close proximity, as forms of
intergenerational support in the Arab region, will be portrayed below.
One of the most prominent forms of living arrangements in the Arab region is co-residence
and is defined as living with at least one adult child or other kin (Sibai, Baydoun & Tohme, 2008;
Tohme et al, 2010). Co-residence facilitates support exchanges through daily contact and sharing of
resources (Cunningham et al. 2013; Yount, 2005). Literature has highlighted different factors that
lead to co-residence within Arab families (Kronfol et al, 2015; Yount, 2005). Typically, in the Arab
society when an older person experiences declining health, widowhood, or is in need of financial
help as well as emotional and instrumental support, co-residence occurs with an adult child,
especially a married son (Yount, 2005; Choi, 2003). Co-residence is more common among older
women than men (Yount, 2009). A study in Tunisia revealed that women of poor health were
residing with their adult children (Yount, 2009). Additionally, data from Tunisia, Jordan, and Egypt
revealed that widowed older women either reside with their children or grandchildren (Angeli &
Novelli, 2017). In Kuwait, a high proportion of older persons are co-residing with a child because
children are expected to look after their parents (Shah et al., 2002). If the older person is of good
health and status, then they provide different types of support in exchange for co-residing with their
child, such as assisting in household chores and providing childcare to the grandchildren (Sibai &
Yamout, 2012). However, if the older person is of poor health and needs personal care, co-residence
is still viewed as beneficial to both the adult child and the older person (Sibai & Yamout, 2012).
This is due to the Arab norms and culture that promote caring for a disabled parent as an extension
of normal family life and a form of familial and religious obligation. Furthermore, adult children
caring for their older parents note personal satisfaction and reward in carrying out caregiving tasks
(Sibai & Yamout, 2012; Shah et al., 2002). These family norms lead to low rates of older persons
living away from family members in the region, because nursing homes and institutions for older
persons remain the last resort for the families (Sibai & Yamout, 2012).
Co-residing is not explicitly a one-way direction, whereby older persons are the ones who
move in with their adult child; rather, there are several instances where adult children move in with
their older parents (Ruggles & Heggeness, 2008; Choi, 2003). Literature has shown that the percent
of adult children residing with their parents is increasing (Ruggles & Heggeness, 2008). For
47
example, in Egypt, newlyweds reside with the husband’s parents until they give birth to their
children (El-Zanaty and Way, 2001; Khadr, 1997; Nawar, Lloyd and Ibrahim, 1995). This living
arrangement helps newlyweds support themselves financially in order to establish a separate
household later on and transition into parenthood (El-Zanaty and Way, 2001). Furthermore, with
today’s high rates of unemployment, low wages, increased age at marriage as well as greater
security coverage for older persons, many older persons are allowing their adult children to co-
reside with them as a way of supporting them financially and preserving the parental obligations
and normative family structure. (Sibai & Yamount, 2012; Yount, 2005; Choi, 2003).
Additionally, in Egypt and Kuwait, wealth and high standards of living promote co-
residence between older persons and children (Khadr, 1997; Shah et al., 2002). This is to preserve
the close kin relationship and serves as a means by which family members provide instrumental,
social and financial support to one another (Khadr, 1997; Shah et al., 2002). However, in certain
instances, wealth and high standard of living drive older persons to live alone since they are capable
of purchasing their own privacy (Kronfol et al., 2015; Tohme et al., 2011). Yet, this defies the
traditional notion of Arab arrangement of intergenerational co-residence and support, since this
privacy can lead to social isolation and deprivation (Kronfol et al., 2015; Tohme et al., 2011; Sibai,
Rizk & Kronfol, 2014).
In certain Arab countries, children reside with their parents until marriage (Khadr 1997;
Nawar et al., 1995; Yount 2005; Yount & Khadr 2008; Cunningham et al., 2013). Nonetheless,
even when married, children still reside in close proximity to their parents’ house (Yount et al.,
2012; United Nations, 2011; Cunningham et al., 2013; Shah et al., 2002). For example, in Egypt,
married daughters often live in the same neighborhood, village, or building as their parents in order
to maintain the visits and close relationship; which are viewed as a form of emotional support
(Yount, Cunningham, Engelman and Agree, 2012; Sibai, Rizk & Kronfol, 2014). A study
conducted by Sinunu, Yount & Afify (2009) revealed that family members live in close proximity
to frail older persons in order to provide caregiving tasks and care. In Qatar, the government has
been promoting close familial residence through providing free housing to extended families that
live in close proximity to maintain the close family relationship and ongoing support between adult
children and their parents (Kronfol et al. 2015). In Kuwait, relatives live within minimal driving
distance to one another to facilitate frequent contact between each other (Shah et al., 2002).
Therefore, living in close proximity to one’s parents is very common in the Arab region, as it
facilitates emotional and instrumental support exchanges between adult children and their parents.
B. Financial, Instrumental, and Emotional Support and Exchanges
Support exchanges in the Arab region are a two-way direction between older persons and
adult children (Kronfol et al., 2015). Data from the national Pan Arab Project for Family Health
(PAPFAM, 2008) studies that were conducted in Algeria, Lebanon and Palestine; the Survey of
Health, Ageing and Retirement (SHARE) in Saudi Arabia; as well as a number of specialized small-
scale studies in Tunisia and Egypt, highlighted that support exchanges are common between older
persons and their children (Sibai et al., 2014). These exchanges, as mentioned above, can be in the
form of financial support, such as providing money and contributing to household expenses;
instrumental support, such as assisting in household chores and taking care of grandchildren; as
well as emotional support, such as visits, calls and expressing affection (Cunningham et al. 2013).
48
Regarding financial exchanges, older persons in certain countries, such as Egypt, expect to
receive financial support from their children, especially sons (Cunningham et al. 2013).
Particularly, financial instability and health-related circumstances or disabilities related to older
persons create need for adult children to provide financial support to their parents (Sibai et al.,
2014). Data from the PAPFAM study in Lebanon indicate that 54.1 per cent and 68.6 per cent of
older men and women receive financial support from their adult children (Sibai et al., 2014). This
percentage increases constantly with age, approaching 72 per cent for those aged 80 years and over
(Sibai et al., 2014). In Ismailia, Egypt, both sons and daughters provide their parents with economic
transfers, yet this was more common for sons than daughters (Cunningham et al. 2013).
Furthermore, other studies conducted in Ismailia, Egypt revealed that mothers receive money and
goods from children, but fathers provide adult children with money and goods. This economic
exchange illustrates that older fathers are disproportionate givers and older mothers are
disproportionate receivers of such exchanges (Yount et al., 2012; Sibai et al., 2014).
The PAPFAM study also revealed that older persons do also provide financial support to
their children and extended family members (Sibai et al., 2014). In Egypt, fathers are obliged to
provide their daughters with financial or material transfer in the case of divorce or neglect by the
spouse (Yount et al., 2012). This data sheds light on the notion that older persons play a key role in
being a social safety net for adult children and their families and should not only be regarded as a
dependent population or passive receivers of support and care (Sibai et al., 2014). In Arab tradition,
men, husbands, and adult sons are the main providers of financial and material support (Yount et
al., 2012). Furthermore, literature has noted that financial support is not only limited between older
parents and adult children; adult siblings also provide financial support to one another, especially
brothers providing for their sisters (Aarssen, 2005). This reinforces the dynamic and structure of the
Arab family, which is based on close-kin relationships and supporting one another.
Support exchanges are not only limited to material and financial support but also include
emotional and instrumental support are also significantly provided (Cunningham et al. 2013;
Kronfol et al., 2015). In the Arab culture, emotional support is highly valued and provided by both
older persons and adult children due to affection, sense of duty and respect (Sibai et al., 2014; Choi,
2003). Emotional support is mainly achieved through daily visits and contact; older persons highly
appreciate frequent visits from non-resident children (Sibai et al., 2014; Cunningham et al. 2013;
Shah et al., 2002). Studies in Kuwait and Egypt, highlighted that children are obliged to visit their
parents and, as previously mentioned, live in close proximity to their parents to maintain the
frequent contact and visits (Yount et al., 2012; Shah et al., 2002).
Regarding instrumental support, the PAPFAM studies showed that between 34% and 40% of older
persons in Algeria, Lebanon, and Palestine provide help to their children in domestic chores and
grandchild rearing (Sibai et al., 2014; Cunningham et al. 2013; Sibai &Yamout, 2012). While other
studies in Egypt indicated that older persons expect their children, particularly their daughters and
daughters in laws to provide them with instrumental support such as household chores
(Cunningham et al. 2013). Assistance with household chores from adult children is regarded as a
sign of respect regardless of the health status or abilities of the older parent (Cunningham et al.
2013). In general mothers, wives and daughters are expected to provide domestic work support
(Yount et al., 2012). Moreover, when older parents health declines and require assistance with
personal care, daughters and daughters-in-law assume the caregiving role and provide assistance to
the older person (Cunningham et al. 2013; Sibai & Yamout, 2012; Abdelmoneium & Alharahsheh,
49
2016; Hussein & Ismail, 2016). However, in some instances adult children may hire a formal
caregiver or care-worker to assist the older person; this support may be seen as financial but serves
to meet the instrumental needs of the older person (Boggatz and Dassen 2005; Sinunu et al. 2009).
Thus, children play an immense role in providing instrumental support to their parents in order to
enhance and maintain their quality of life as well as their survival (Abdelmoneium & Alharahsheh,
2016). The instrumental support is not only limited to daily chores, and personal care; children
assist their parents in grocery shopping, managing symptoms, coping with illness behaviors,
carrying out illness- related treatments, accessing resources, communicating with health care
professionals, assisting in financial matters and bill-paying (Abdelmoneium & Alharahsheh, 2016;
Abyad, 2001; Walker, Pratt and Eddy, 1995).
Conversely, literature had shed light on other factors that cause children to provide
instrumental support to their parents other than norms and culture (Cunningham et al. 2013). In
Egypt, children assist their parents with household chores as a pay back for receiving economic
transfers from them (Cunningham et al. 2013). Also, as previously stated, residing with parents
influence children’s decision in providing instrumental support to their parents (Cunningham et al.
2013). Therefore, this signifies that children’s decision to provide their parents with support is not
only shaped by the Arab norms but also on the support exchanges they receive from their parents
(Cunningham et al. 2013).
III. METHODOLGY
The goal of the case study was to explore intergenerational support between older persons and adult
children in Beirut, Lebanon and factors that promote it. To achieve this objective, this study
employed a qualitative research design that relies on gathering data on participants’ views of
intergenerational support within their family. In this context, an in-depth understanding of
intergenerational support more specifically living arrangements and support exchanges that occur
within and between family members was sought, from the participants’ own perspectives. This
study therefore used an inductive approach to generating knowledge through conducting in-depth
interviews with older persons, adult children, and stakeholders. Data from the in-depth interviews
were subjected to thematic analysis, a method used to identify, analyze, and report patterns within
data (Braun & Clarke, 2008).
Thus, in this study, open-ended, semi-structured interviews were conducted with a sample of 1)
older persons; 2) adult children; and 3) key informants of homes for older persons. The recruitment
methods for the three groups of participants are detailed below.
A. Recruitment and Sampling of Participants
A sample of 14 Lebanese older persons residing in Beirut but from different socioeconomic statuses
and gender were recruited to participate in an in-depth interview. The main inclusion criterion was
that the older person should be 60 years old and above and non-institutionalized and has children. A
purposive non-probability sampling was used to approach eligible participants and continued until
saturation was achieved.
Similarly, a sample of 14 Lebanese adult children from different socioeconomic statuses and gender
were recruited to participate in an in-depth interview, with the following inclusion criteria: being 25
50
years and above. A purposive non-probability sampling was used to approach eligible participants
and continued until saturation was achieved.
Finally, we recruited three key informants who are managing homes for older persons in Greater
Beirut from the Directory of Elderly Institutions in Lebanon. Each home for older persons has a
different criterion for enrolling older persons in their institution, provides different services, and
cater to older persons from different socioeconomic and health statuses.
B. Data Collection and Analysis
With the consent of the participants, the interviews were audio recorded and conducted by a
research consultant who has expertise and previous academic knowledge and training in semi-
structured interviews and qualitative research. Interviews with older persons and adult children
started with broad questions that explored the participant’s background. They were followed by
questions pertaining to living arrangements, financial, instrumental and emotional support
exchanges as well as questions that focused on the limitations of providing and receiving
intergenerational support, satisfaction of the participants with intergenerational support and the role
and shortcomings of the government in providing services for older persons, adult children. As for
homes for older persons, the interview started with the services provided by the home and overview
of the older persons residing there followed by questions related to financial, instrumental and
emotional support exchanges followed by additional questions that focused on the limitations of
providing and receiving intergenerational support, satisfaction of older persons with
intergenerational support and the role and shortcomings of the government in providing services for
homes for older persons. Interviews with the participants were carried out either in colloquial
Arabic (n= 23) or English (n=1 0), depending on the preference of each participant. The interviews
with the older person and adult children lasted about 45-60 minutes as for the stakeholders it lasted
about 20-30 minutes. The interviews were transcribed verbatim in English. The data was then
examined using thematic analysis, a method used to identify, analyze, and report patterns within
data.
C. Process of Informed Consent and Protection of Human Subjects in the Research
The formal process of informed consent for each participant took place on the day of the scheduled
interview. Before the day of the interview, an in-person discussion or phone call was used to
contact the participant to briefly explain the study objectives, to obtain a tentative approval to
participate and to schedule a time for the interview. On the day of the interview and before
conducting the interviews, the interviewer introduced herself and explained to the interviewees: 1)
the rationale behind the project and its significance, 2) how the collected data will be handled, and
3) how the findings from the research will be disseminated. Then, the participant’s approval was
solicited to participate in and record the interview. In case the participant refused to audiotape the
interview, the interviewer took notes instead. Participants were told that they could opt out of the
study at any point during the interview and the study without any negative consequences.
D. Timeline and Procedures
This case study was conducted from June 2017 until August 2017.
51
IV. Discussion
A. Participants Overview
On average, older persons in the population sample of older persons in this study were
between 60 to 70 years of age. Most of the participants were married at the time of the interview,
with one individual who was divorced and two widows. Additionally, two participants were never
married and also childless. The average highest level of education attainment was a university
degree, but some participants had highest education level attained as low as grade 5. The majority
of participants were retired. They had, on average, three children and the youngest of the children
was 28 years of age. The average level of educational attainment among participants’ children was a
university degree, both for sons and daughters. The majority of sons were married, while some
daughters were still single. The participants’ children had, on average, three children. Furthermore,
only three participants had parents that were still living.
The adult children in the population sample were between 30 to 53 years of age. An equal
proportion of the participants were married and unmarried. The majority of the participants’ have a
university degree and were currently working. The married participants had, on average, three
children. All of the participants’ parents were alive and most were retired. On average, the
participants had three siblings, and the majority of the siblings were married.
Detailed demographic information of participants by interview type is indicated in Table 1.
Table 1: Demographic Information of Participants from Interviews
Frequencies and percent distribution of interview participants by background characteristics,
Intergenerational Support In Lebanon, 2017.
Interviews with older persons
Interviews with adult
children
Total Number of Participants 14 14
Gender
Females 50 % 57%
Males 50%% 43%
Mean Age
Females 69 38
Males 68 36
Education
Primary 43% -
Intermediate 7% -
Secondary 21% 21%
University 29% 79%
52
B. Homes for Older Persons Overview
The homes for older persons were diverse in the services they provided and enrolled older
persons of different characteristics. One home is an assisted living center where all the rooms are
private, daily meals are provided, nurses and geriatric doctor are available at all times and various
activities and outings take place. Furthermore, the older persons who are capable of going out have
the liberty to do so. Other older persons enrolled there are semi-independent, meaning they are able
to bathe, eat, dress, and transport themselves. Some live there because they do not want to deal with
the hassles of daily life such as cooking and cleaning, while others live there because their children
live abroad or they do not have close family support. The age range of residents is between 75 to 95
years of age, and the majority are females. Most of the older persons were married, have on average
two children, are of high socioeconomic status, have university degrees, and used to work. The
older persons expressed that they themselves were the main decision makers when it came to
enrolling in the organization.
The other home is an accredited charitable organization that serves around 300 older persons
that suffer from health disabilities, such as Alzheimer’s, diabetes and Parkinson’s. It is equipped
with numerous doctors, nurses, dietitians, psychologists, and physiologists that cater to the needs of
older persons, as well as outpatient clients. They serve meals daily, as well as provide laundry and
tailoring services to their in-house patients. The average age of the older persons residing in this
home is mainly 80 years and above, and the majority are married. There are an equal number of
enrolled males and females. The older persons come from various educational backgrounds and
have varying numbers of children. In this home, usually, the children were the main decision
makers when it came to enrolling their parents in the organization. The children still serve as their
guardians in case of an emergency.
Finally, the last home is a non-profit organization that serves older persons who are 65 years
of age and above, whether independent, dependent or suffer from Alzheimer’s or chronic illnesses.
It is composed of geriatric doctors, nurses, dietitians, speech therapist, and occupational and
psychomotor therapists that follow up and provide care to the older persons. It also provides laundry
services, daily meals, outings, and activities. The older persons who are capable of going out have
the liberty to do so. The rooms are of various types, such as a private single rooms or rooms where
two to three older persons reside together. The room choice depends on the preference of the older
person and availability. The average age of the older persons residing in this home is 80 years of
age, and the majority are females. 25 per cent of the older persons are not married while 75 per cent
are married with an average of four children. During the past five years, there has been a shift in the
educational level of older persons whereby the majority now have a university degree and used to
work. The members of the family usually refer older persons to this organization; however,
recently older persons are personally requesting to enroll there.
53
C. Living Arrangements
The findings of this research highlight that the majority of older persons that are either
married or widowed are co-residing with unmarried and/or married children in parent-headed
households. Of the participants in this study, three older persons are co-residing with an older
parent, whereby two other older persons identified themselves as the head of the household.
Furthermore, one older person resides alone five days a week, while, for the remaining two days of
the week, s/he resides with a married daughter. Similarly, the majority of adult children, regardless
of gender or marital status, are residing with their parents in parent-headed households. Two adult
children noted that their parents are residing with them in child-headed households.
Factors leading to intergenerational co-residence
included: the inability of adult child to afford to lead a
separate household, the adult child is unmarried, the adult
child or older person is in need of financial support, the older
person’s health is declining, and the desire to maintain close
family relationship. These findings highlight that economic
resources mainly drove participants to co-reside; needing
financial support and the inability to afford to lead a separate
household dictated living arrangements. Furthermore, the
research findings emphasize that inter-generational co-
residence is still prominent in Beirut, regardless of one’s
socioeconomic status. Data from Egypt and Jordan have
depicted similar findings, whereby co-residence is still
prominent among older persons and adult children (Angeli &
Novelli, 2017). Literature highlights that even though intergenerational co-residence is declining in
the majority of countries, traditional family forms will remain resilient to change, which is furthers
supported the findings of this research (Ruggles and Heggeness, 2008). However, the results of this
research are contrary to the findings of Tohme et al. (2010),which showed that Lebanon is
following a western model whereby wealthier older persons are more likely to reside alone in order
to purchase their privacy (Tohme et al., 2010).
“My son wants to buy a
house, so he asked whether
he, his wife and son can
reside with us until he saves
enough money to purchase
his own house.” -Interview
with male older person,
married, age 66
“I came back from the Gulf
and started working in
Lebanon and purchased a
house in Verdun. I decided to
let my parents reside with me
since I thought to myself, they
are getting older and we
should spend more quality
time together.” -Interview
with female adult child,
unmarried, age 42
“My father is very sick and
lives in a building right next
to me with 2 female nurses.
Being so close to him makes
it easier for me to go check
up on him and, in case
anything happens, I am right
here.” -Interview with female
older person, married, age 65
54
Regarding living in close proximity to family members, the research findings revealed that
two older persons where residing in close proximity to older parents. The majority of older persons
stated that their adult children resided near them. However, a minority of older persons mentioned
that some of their children were not living in close
proximity to them due to their inability to afford high
prices of housing in the Beirut region. Three older
persons stated that some of their adult children were
living abroad due to work purposes. However, distance was
not described as a barrier for intergenerational support
exchanges and relationship between older persons and
children. Additionally, six adult children stated that they
were residing in close proximity to their parents.
When asked about the reasons for living in close
proximity to parent or child, participants mentioned that they chose to live close by in order to
maintain daily contact, to look after an older parent and because close proximity housing facilitates
daily support exchanges between kin. These findings are consistent with literature available that
emphasize that in the Arab region, living in close proximity to kin is mainly related to maintaining
daily contact and providing support exchanges and caregiving roles (Kronfol et al., 2015; Yount et
al., 2012; Sinunu, Yount & Afify, 2009).
Yet, with the new rent law in Lebanon, which permits the incremental increase of rent
prices leased before 1992, several participants residing in old rent houses expressed that an increase
of their residential rent price may possibly alter their living arrangements (Daily Star, 2017).
Participants noted that if older persons and working adult children are residing in an old rent house,
then a new increased rent is automatically applied. Yet, if only older persons are residing in the
house, the new rent law is not applicable. This issue may cause adult children to leave the house and
reside in a separate household in order to maintain the old rent price of their parents’ house.
Additionally, with high housing prices in Beirut, adult children may only be able to afford to reside
in areas outside of Beirut. This issue not only disrupts potential support to older persons provided
through inter-generational co-residence, but also the support provided through living in close
proximity to another. Moreover, if older persons are financially dependent, then adult children who
are responsible for their parents’ expenses and would usually pay for the older persons rent are
more pressured to not co-reside with their parent in order to maintain the lower rent cost. Therefore,
the new rent law serves as barrier to promoting intergenerational co-residence and living in close
proximity to family members, which other countries in the region are actively seeking to promote
(Kronfol et al., 2015).
“My husband and I bought a
house next to both my parents and
his parents, because whenever I
need something or they need
something, we are only five
minutes away.” -Interview with
female adult child, married, age
24
55
D. Financial exchanges
Findings from this study highlighted that
financial support is mainly transferred upward from adult child
to older person and from older person to older parent.
Nevertheless, when asking older persons about the
financial support they provide to their children,
participants noted that they usually provide gifts rather than
money to adult children and grandchildren. Only one older
person noted providing adult children with pocket money on
regular basis. Two male older persons noted establishing a
business that their children took over; they perceived
themselves as indirectly contributing and supporting their children’s’ financial situation.
Furthermore, older persons with living older parents mentioned that they provide money on
monthly basis to their parents as well as pay for their medical expenses and nurse assistance.
Regarding receiving financial support, the
majority of older persons noted receiving money on
monthly basis from both male and female adult children.
Respondents noted that they use the money to pay rent, phone
and electricity bills, as well as to buy personal goods, goods
for the house and medications. Widowed, divorced, and
disabled participants expressed the importance of their
children in supporting them financially. This reflects that life
events may impose financial constraints on older persons and
affect their ability to support themselves. This is
particularly common for female older persons since women
in the Arab region marry at a young age and outlive their male partners (Hogman 1999, Mehio-
Sibai, Beydoun &Tohme, 2008). Additionally, one older person noted that the money received from
adult children was mainly used to pay for nursing assistance expenses for the older person’s parent.
This highlights that inter-generational support in Beirut is found across generations.
A few older persons highlighted that, at times, only one adult child, usually an unmarried
one, is taking care of the monetary expenses. The reason
for this was usually due to other children who are married
having obligations towards their own family and cannot
provide for older persons. This finding is consistent with
the literature, which states that married children have
financial obligations within their own nuclear families and
cannot always provide for their parents (Sinunu et al.,
2008).
Older persons noted receiving gifts from adult
children on Mother’s Day, birthdays, and other special occasions, regardless of their children’s
socioeconomic status. When asked about financial support provided to or received from other
family members, a few participants noted either providing money to a parent-in-law or receiving
money from a son-in-law. This signifies that individuals, regardless of age, do not only have
“I do not give money to my
married son, but whenever I
go shopping I buy clothes
and toys for his children.
When there are occasion I
buy him gifts for his house”
Interview with female older
person, married, age 65
“My wife’s brother, the only boy
between nine girls, cannot provide
for my mother-in-law. Thus, I pay
for my mother-in-law’s house
rent.” -Interview with male older
person, married, age 65
“I opened up a minimarket
40 years ago, now my 2 sons
are running it, without me
they would not have been in
this job and I still handle the
finances of the business”
Interview with male older
person, married, age 70
56
obligations towards their own family, but also to extended family, including relatives by marriage.
This finding is also consistent with the literature, which states that married individuals have two sets
of parents, their parents and their spouse’s parents, who constitute central networks for exchanges
of support (Rossi & Rossi, 1990).
Interviews with adult children revealed that 65% of adult children provide money on
monthly basis to their parents. The money provided is used for paying rent, electricity, and phone
bills and buying goods for the house. Adult children noted either sharing such expenses with
siblings or being the sole providers of monetary support. Reasons for providing financial support
included parents’ inability to provide for themselves and adult child’s obligation for residing in a
parent-headed household. Adult children residing with parents in a child-headed household noted
providing the money to parents in order for the parents to deal with the household expenses. These
findings are consistent with the PAPFAM study results, which indicated that a substantial number
of adult children provide financial support to their parents (Sibai et al., 2014). Furthermore, all adult
children in the present study noted purchasing gifts for parents on Mother’s Day, birthdays, and
special occasions. Regarding parents’ medical expenses, the majority of adult children noted that
they included their dependent parents on their own insurance coverage by being enrolled in the
National Social Security Fund (NSSF) or a syndicate. These protection schemes provide working
individuals with insurance coverage and allow them to enroll dependent family members, including
older parents.
As for providing financial support to other family members, four adult children noted providing
money to siblings or unmarried aunts. One male and female participant noted offering financial
support to a divorced sibling. Moreover, one female participant noted paying for her unmarried
aunt’s house rent. A male participant stated lending his male siblings money when they are in need.
These findings highlight the inter-connectedness of the Arab family, within which support is not
only limited between parents and children but expands between siblings and other family members
(Aarssen, 2005)
As for receiving financial support from parents, the majority of adult children noted they and their
siblings only receive gifts or money from parents on special occassions, such as marriage,
birthdays, Christmas and Eid Al Adha. Two female older persons noted that parents were paying for
their sibling’s university tuition fees and providing them with a monthly allowance. One male
participant mentioned that his father purchased a house for him when he got married, and one
female participant noted that her parents buy her gifts when they travel abroad. Only one participant
noted her divorced sibling receiving a month allowance from her parents. Additionally, two adult
children noted that their fathers pay for their medical insurance; they stated that this relieved them
financially from the burden of paying medical insurance, which they described as costly.
All three key informants managing homes for older persons highlighted that residence fees
for the majority of older persons were either covered by the older persons themselves, the Ministry
of Public Health or the Ministry of Social Affairs. There were only a few cases whereby adult
children were paying for the older person’s residence fees. Nonetheless, key informants reported
that children provide their parents with gifts, such as clothes. Furthermore, the key informant of the
assisted living center noted that several adult children hire special nurses or helpers to assist their
parents in the center.
57
E. Instrumental Support
The majority of female older persons noted providing instrumental support to adult children in the
form of looking after grandchildren and meal preparation.
Participants expressed happiness when taking care of
grandchildren and regarded it as part of their grandparenting
role. This finding is consistent with Cunningham et al. (2013),
which found that older persons in Ismailia, Egypt provide care
for grandchildren. One female older person noted that, at
certain times, she takes care of her son’s governmental papers
since he lives abroad. Additionally, two female older persons
were caregivers to their parents and accompanying them to
doctor visits at the time of the assessment. As for older male participants, the majority assisted adult
children with governmental papers. However, when asked about instrumental support received from
adult children, both male and female participants noted adult children mainly transport them to
certain events and accompany them to medical and social visits. One male older person noted
having diabetes and rheumatism, causing him to depend on his
wife and kids for personal care and assistance. One female
participant noted that her daughter assists her with household
chores and grocery shopping. When asked about instrumental
support provided by residing daughters-in-law, one female
older person noted angrily that she was receiving no assistance
in the household chores from her daughter-in-law.
Furthermore, one male participant mentioned that the daughter-
in-law works and does not provide any household assistance
since there is a helper at home. The latter example is
inconsistent with the literature which states that daughters-in-
law are normally expected to provide domestic work support, especially when older persons or in-
laws are providing any form of support (Yount et al., 2012).
“Before my son goes to his
house, he passes by my house
and eats lunch, because he is
used to my food.” -Interview
with female older person,
married, age 68
“When my daughter and
husband go out at night, they
bring the grandchildren over
to my house with the helper
so I look after them.” -
Interview with female older
person, married, age 65
“I told my son that I accepted that he, his wife and daughter could
live with me, but at least his wife should help me with the house
chores in exchange. She cleans her room only and leaves the house
till my son comes back home.” -Interview with female older person,
widowed, age 70
58
Regarding instrumental support provided by adult children to their parents, the majority of
both male and female adult children noted accompanying parents to certain doctors’ visits
and social events, as well as transporting them to certain places. As for female participants
residing with parents, one participant stated that she assists with the household chores after
work, while two other participants noted that they hired a part-time helper for the household
chores to relive themselves and their parents from such duty. Additionally, male participants
noted being involved in parents’ governmental papers and assisting them with passport
renewals or any needed document. Participants
noted that siblings residing in Lebanon assisted them
in the aforementioned instrumental support provided to
parents. Furthermore, they mentioned that siblings
visiting from abroad also play a role in providing
instrumental support to parents; this was regarded a
relief from the participants as they now had a
helping hand. Only one participant noted that a
visiting sibling from abroad did not provide any
instrumental assistance, due to the sibling’s visit
being a vacation.
Additionally, participants noted providing
instrumental support to their siblings. Two female participants noted babysitting their female
siblings’ children and transporting them to certain activities. Male and female participants
helped siblings living abroad with governmental papers or payments that need to be
conducted in Lebanon.
Findings related to adult children receiving instrumental support from parents highlighted
that the majority of working adult children, regardless gender, were receiving instrumental support
from parents, especially mothers. Instrumental support received from adult children’s parents
included assisting in household chores, conducting personal errands and grocery shopping, assisting
with financial management and governmental papers, meal preparation, helping with grandchildren
and taking care of the adult child when he or she is sick. Participants described that mainly their
fathers were involved in their financial and governmental matters. They expressed that their long
working hours requires them to ask for instrumental support from parents. Moreover, they noted
that they receive such support from parents more often than they provide it to parents. Interestingly,
several participants stated requesting certain support from their parents, specifically fathers, in order
to maintain their role and involvement in the family.
“I tell my dad to come to the moukhtar with me when I want documents
for my passport renewal so that he talks to the moukhtar and still feel
he is the man of the house and has a purpose.” -Interview with female
adult, never married age 38
“When my dad fell and hit his
head, my sister came from
abroad and helped us in
providing care for my father.
This was a relief, because my
sister and I were able to go to
work and did not have to take
days off to help our mum.” -
Interview with male older
adult, never married, age 33
59
Furthermore, one female participant noted that her mother-in-law prepares meals for her to
bring to work, and another stated that her mother-in-law babysits her son. These finding sheds light
on the fact that mothers-in-law provide support to daughters-in-law, which contradicts some
literature that highlights mainly daughters-in-law providing assistance to mothers-in-law.
Participants mentioned that siblings received similar instrumental support from parents. One
participant noted that her male sibling eats a certain type of food, thus, her mother prepares separate
meals for him. Another participant noted her mother travelled abroad to assist her sister with her
baby delivery.
Conversely, interviews with key informants highlighted that adult children rarely provide
instrumental support to their parents. This was due to the notion that adult children depend on the
institution or home for older persons to take care of their parents. There were a few cases noted
where adult children transported older persons to certain places and followed up with the
institution’s physician.
“Children perceive their parents as a burden and when they enrol them here, we
tell them that they need to stay involved in their parent’s life, but rarely any child
does so. Even when we need to hospitalize the older adult, we call their children
and none care, as if the older adult is solely our responsibility now.” -Interview
with a male key informant at an older persons’ institution
“My wife and I have full time jobs, my mother comes up to my house with her
helper, they iron our clothes and clean the dishes, this helps my wife a lot with
the house hold chores”. Interview with male adult, married, age 32
60
F. Emotional Support
Emotional support, mainly provided through calls and visits, was highly reported by older
persons and adult children, regardless of geographical proximity to one another. Older persons
perceived these types of emotional support as highly valuable and more essential than receiving
material support. Furthermore, a large majority of children abroad call and chat with parents and
siblings’ everyday as reported by both older persons and adult children. The majority of female
older persons noted providing adult children with affection such as hugs and kisses whereas male
older persons provided advice. This finding was concurred by male and female adult children that
stated that mothers mainly provided affection and
fathers were sought for advice, mainly work related. This
highlights that the differences in the types of
emotional support provided by each parent may be due
to their different roles in the Arab society, whereby
mothers are involved childrearing, and fathers in
providing financially for the family (Yount et al.,
2012). Furthermore, one female older person with a
viable older parent noted visiting her father two to three
times per week and calling him everyday.
As for receiving emotional support from adult
children, the majority of older persons noted receiving health related advice from children as well as
attention when they seem down. Affection such as hugs and kisses were mainly provided when
family members meet. Additionally, several older persons residing with adult children noted
spending quality time at home. Only, one female older person noted her children resorting to their
room when they come back from work. Similarly, adult children reported providing emotional
support to their parents in the form of visits, calls, advice and quality time. Adult children not
residing with parents called on average daily and visited parents once a week. Regarding expressing
affection, female adults noted kissing and hugging parents whereas male adults mainly kissed their
parents hand. Additionally, adult children noted visiting viable grandparents and extended family
members on regular basis. Interestingly, findings from interviews with both older persons and adult
children highlighted that family’s set designated days for family gatherings. For example, one
older person noted that every Saturday her children and grandchildren come over to visit her
whereby, she cooks a meal and they spend the day together while another stated that her mum
spends every Monday and Saturday at her house. These findings highlight that emotional support is
essential for the Arab family and signifies the closely-knit family relations as well as family
integrity and loyalty (Kagitcibasi, Ataca & Diri, 2010).
Key informants reported varied insights regarding emotional support. Two key informants
noted that adult children and grandchildren visit and call older persons regularly. During the visits,
both older persons and children provide affection in the form of hugs and kisses. In contrast, the key
informant of the charitable organization noted that visits and calls were minimal from adult
“My mother visits me every Thursday with my brother and sister and on
Saturday my wife and I as well as my siblings go visit her”. Interview
with male adult, married, 55 years old
“My parents always praise me.
They always tell me “May God help
you succeed in life”. I admire this
so I learned to always praise them
as well and tell the May god keep
you by my side””. Interview with
female adult, unmarried, 31 years
old
61
children. It was reported that one in every seven adult child would visit their parent. Nonetheless,
all key informants reported conducting events on occasion such as mother’s day and Christmas and
inviting adult children in order to maintain their involvement in their parents lives and promote
emotional support.
G. Satisfaction with Intergenerational Support
Both older persons and adult children noted satisfaction with the support exchanges and close knit
relationship within their family. Yet, all participants noted that distance and time was a limitation
for the family to spend quality time together. Adult children noted that having siblings living abroad
places greater pressure on them since they need to solely provide instrumental support to their
parents and at certain times financial support.
The results of this research highlighted that the majority of older persons did not have a
favorite child, they noted loving all their children equally. Only one female older person reported
appreciating her youngest son since he financially supported her. Furthermore, all older persons
expressed that their children are obliged to take care of since they provided for them when they
were younger. This finding was concurred by adult children, whereby they noted that providing
support to their parents is driven by what their parents did to them. They described such support
exchanges as a sign of gratitude. Moreover, a minority of older persons stated that social and
religious obligations also play a role in providing support to parents.
Never married older persons and never married
adult children, especially female adult children aged 32
and above expressed great concern regarding their
childless status. They noted that even though they
were currently independent and were experiencing
support exchanges with their parents, the notion of not
having children was perceived as very critical
especially for older persons. They noted having
good relationships with their siblings, nieces, and
nephews and may depend on them for support
“When adult children come visit their parents, they are sitting next to
each other and holding hands. At times, the adult child would feed the
parent or peel fruits for them”. Interview with female key informant
“If my brothers do not send money on time, then I have to put extra
money from my salary. This upsets me because they do not know how
the situation is at home since they are not living it day by day.
Interview with male adult, married, 32 years old
“The question you just asked me about
expecting my children to look after me
when I am older stressed me out. As I
told you I am not married and I do not
like to this about this question, it is
very stressful
Interview with female adult child,
never married, 32 years old
62
exchanges in the future; however, from their own experience they receiving support know from
their own children would be different.
V. OPPORTUNITIES AND CHALLENGES
The research findings revealed that intergenerational support is vital in the Arab society and
embedded in the culture and tradition. However, it also highlighted several factors that play a role in
enhancing or disrupting such support exchanges as well as the quality of life of older persons.
These factors will be depicted below.
Interviews with adult children shed light on an important aspect, which is the continuous
involvement of parents, particularly fathers in family matters. For example, adult children requested
from parents certain errands for the purpose of keeping them active and busy. This supports the
United Nations objective, which is “Tapping the Talents, Contributions and Participation Older
Persons in Society” through enabling older persons to contribute in their families, communities and
societies at large (United Nations, 2017). Unfortunately, in Lebanon such motto is only triggered by
children since on a national level, older persons lack recreational activities and are not involved in
decision making.
Interestingly, social media plays a substantial role in preserving contact between family members.
Findings from this study highlighted that Whatsapp groups, face time and Skype were the main
platforms whereby family members communicated with one another especially when certain family
“My father likes to read but there are not public library’s for him to go
to and I do not see the Ministry of Tourism encouraging older adults to
go watch plays and also there are no reduced rates for older adults to
go to the cinema.
Interview with female adult, never married, 42 years old
“My brothers and I got my father a red license plate. Even though, the
licence plate is expensive we got him it because if he left his job, he can
work as a driver. This will keep him active and still make him earn
money.
Interview with male adult, married, 32 years old
“It is very hard not having children in old age. I know my siblings and
nieces and nephews are here for me but I see how I am with my parents
and I see how my mum and dads nieces and nephews are with them, its
different. I am obliged to take care of my parents and I enjoy it but at the
end when I am old my extended family is not obliged to take care of me.
The pressure is all on me in taking care of my self”
Interview with female older person, never married, 60 years old
63
members were living abroad. Several older persons from the study were using such platforms to
chat with children, grandchildren, and friends. They noted that it was convenient and most
importantly enables them to directly see their loved ones. This is consistent with findings that
describe the computer and social media as key players in enabling older persons to remain in touch
and stay involved in the activities in the lives of their children, grandchildren and friends (Robnett
& Chop, 2013).
Universal Health Coverage (UHC) for older persons and retirement pension schemes are
lacking in Lebanon (Kronfol et al., 2015). This indirectly affects the autonomy of older persons, as
they need to look to their families for those assurances. The findings revealed that only one older
person was benefitting from retirement money while the rest depended on adult children or savings.
Furthermore, both older persons and adult children noted that medications and insurance for older
persons in Lebanon is very expensive. Adult children and older persons with viable parents
described this issue as a burden since they needed to provide the medical and financial necessities
for their parents. Furthermore, participants noted that homes for older persons in Lebanon were
either very expensive or lacked professionalism. They mentioned that the government should
establish quality governmental public homes for dependent older persons as well as provide pension
schemes to older persons who did not work in the government. Older persons were described as the
backbone of society and the Lebanese government was neglecting this segment of the population.
Moreover, adult children highlighted that when the government assists them with their parent’s
medical expenses then their money can be invested in providing luxury support to their parents such
as taking them on trips and buying them gifts.
Additionally, increasing life expectancy and the proportion of older persons, lower fertility,
immigration, wars, underemployment, modernization and socioeconomic advances have also
caused strains on the Arab family system and affected the traditional values and intergenerational
ties (Kronfol et al., 2015; Yount et al., 2012; Glicksman & Ayden, 2009).
“I schedule a Skype session with my son and daughter who live in
Dubai. I find it very fruitful, it is even better than the quality time spent
if they were here because on Skype we are committed to this session
while if they liee here I would see them for 5 minutes only since they
have to go out or are at work the whole time
Interview with female older adult, divorced, 65 years old
“My father is very old, it causes me so much stress that I need to take
care of him. I am old too and need time to rest. The elderly homes in
Lebanese cost 1,000-2000$ per month, if they were cheaper I would
have placed him there, that way I would have time to rest and see my
family more often.
Interview with female older adult, married, 65 years old
64
In sum, this chapter has explored intergenerational support in the Arab region with a focus
on intergenerational support among older persons and adult children residing in Beirut, Lebanon.
Support exchanges were classified under living arrangements, financial, instrumental, and
emotional support. Furthermore, it provided insight to families’ satisfaction with intergenerational
support and the drivers and barriers to providing and receiving support exchanges.
65
REFERENCES
Aarssen, L. W. (2005). Why Is Fertility Lower in Wealthier Countries? The Role of Relaxed
Fertility‐Selection. Population and Development Review, 31(1), 113-126.
Abdelmoneium, A. O., & Alharahsheh, S. T. (2016). Family home caregivers for old persons in the
Arab region: perceived challenges and policy implications. Open Journal of Social
Sciences, 4(01), 151.
Abdulrahim, S., Ajrouch, K. J., Jammal, A., & Antonucci, T. C. (2012). Survey methods and aging
research in an Arab sociocultural context—A case study from Beirut, Lebanon. Journals of
Gerontology Series B: Psychological Sciences and Social Sciences, 67(6), 775-782.
Abudabbeh, N. (1996). Arab families. Ethnicity and Family therapy, 2.
Abyad, A. (2001). Health care for older persons: A country profile—Lebanon. Journal of the
American Geriatrics Society, 49(10), 1366-1370.
Allen, K. R., Blieszner, R., & Roberto, K. A. (2000). Families in the middle and later years: A
review and critique of research in the 1990s. Journal of Marriage and the Family, 62, 911-926.
Angeli, A., & Novelli, M. (2017). Transitions in Late-Life Living Arrangements and Socio-
economic Conditions of the Elderly in Egypt, Jordan and Tunisia. In Economic Research
Forum Working Papers (No. 1083).
Aykan, H., & Wolf, D. A. (2000). Traditionality, modernity, and household composition: Parent-
child coresidence in contemporary Turkey. Research on Aging, 22(4), 395-421.
Boggatz, T., & Dassen, T. (2005). Ageing, care dependency, and care for older people in Egypt: a
review of the literature. Journal of Clinical Nursing, 14(s2), 56-63.
Choi, N. G. (2003). Coresidence between unmarried aging parents and their adult children: Who
moved in with whom and why?. Research on Aging, 25(4), 384-404.
Cunningham, S. A., Yount, K. M., Engelman, M., & Agree, E. (2013). Returns on lifetime
investments in children in Egypt. Demography, 50(2), 699-724.
Frederica Masri (2017, March 31). Rent law set to go into effect after ruling. The Daily Star.
Retrieved from https://www.pressreader.com/lebanon/the-daily-star-
lebanon/20170331/281539405796786
Hussein, S., & Ismail, M. (2017). Ageing and elderly care in the Arab region: policy challenges and
opportunities. Ageing International, 42(3), 274-289.
66
Kagitcibasi, C., Ataca, B., & Diri, A. (2010). Intergenerational relationships in the family: Ethnic,
socioeconomic, and country variations in Germany, Israel, Palestine, and Turkey. Journal of
Cross-Cultural Psychology, 41(5-6), 652-670.
Khadr, Z. A. (1997). Living arrangements and social support systems of the older population in
Egypt (Doctoral dissertation).
Khan, H. T. (2014). Factors associated with intergenerational social support among older adults
across the world. Ageing International, 39(4), 289-326.
Kronfol, N. M., Rizk, A., & Sibai, A. M. (2015). Ageing and intergenerational family ties in Arab
countries/Vieillissement et liens familiaux intergénérationnels dans les pays arabes. Eastern
Mediterranean Health Journal, 21(11), 835.
Lowenstein, A. (1999). Intergenerational family relations and social support. Zeitschrift für
Gerontologie und Geriatrie, 32(6), 398-406.
Mehio-Sibai, A., Beydoun, M. A., & Tohme, R. A. (2009). Living arrangements of ever-married
older Lebanese women: is living with married children advantageous?. Journal of Cross-
Cultural Gerontology, 24(1), 5-17.
Nawar, L., Lloyd, C. B., & Ibrahim, B. (1994). Womens autonomy and gender roles in Egyptian
families. [Unpublished] 1994. Presented at the Population Council Symposium on Family
Gender and Population Policy: International Debates and Middle Eastern Realities Cairo
Egypt February 7-9 1994.
Rossi, A. S., & Rossi, P. H. (1990). Of human bonding: Parent-child relations across the life course.
New York: Aldine de Gruyter.
Ruggles, S., & Heggeness, M. (2008). Intergenerational coresidence in developing
countries. Population and Development Review, 34(2), 253-281.
Shah, N. M., Yount, K. M., Shah, M. A., & Menon, I. (2002). Living arrangements of older women
and men in Kuwait. Journal of cross-cultural gerontology, 17(4), 337.
Sibai, A., & Yamout, R. (2012). Family-based old-age care in Arab countries: between tradition and
modernity (63–76). Population Dynamics in Muslim Countries: Assembling the Jigsaw.
Heidelberg, Springer Berlin.
Sibai, A. M., Rizk, A., & Kronfol, N. M. (2014). Ageing in the Arab region: Trends, implications
and policy options. Center for Studies on Aging (CSA), ESCWA and UNFPA.
Sinunu, M., Yount, K. M., & El Afify, N. A. W. (2009). Informal and formal long-term care for
frail older adults in Cairo, Egypt: family caregiving decisions in a context of social
change. Journal of Cross-Cultural Gerontology, 24(1), 63-76.
67
Tohme, R. A., Yount, K. M., Yassine, S., Shideed, O., & Sibai, A. M. (2011). Socioeconomic
resources and living arrangements of older adults in Lebanon: who chooses to live
alone?. Ageing & Society, 31(1), 1-17.
Walker, A. J., Pratt, C. C., & Eddy, L. (1995). Informal caregiving to aging family members: A
critical review. Family Relations, 44(4).
Yount, K. M. (2005). The patriarchal bargain and intergenerational coresidence in Egypt. The
Sociological Quarterly, 46(1), 137-164.
Yount, K. M., & Khadr, Z. (2008). Gender, social change, and living arrangements among older
Egyptians during the 1990s. Population Research and Policy Review, 27(2), 201-225.
Yount, K. M. (2009). Gender and intergenerational co-residence in Egypt and Tunisia. Population
Research and Policy Review, 28(5), 615.
Yount, K. M., Cunningham, S. A., Engelman, M., & Agree, E. M. (2012). Gender and material
transfers between older parents and children in Ismailia, Egypt. Journal of Marriage and
Family, 74(1), 116-131.
68
CHAPTER 4
FUTURE OF OLD AGE IN THE ARAB REGION
ROADMAP TOWARDS AGEING WITH DIGNITY
DRAFT – NOT FOR CIRCULATION
69
Introduction
As most Arab countries are in the midst or in advanced stage of their demographic transition, they
are experiencing shifts in the relative numbers of children, working-age population and older persons.
By 2030 and 2050, most countries in the region will experience an increasing number and share of
older persons, with a simultaneous rise of the number and proportion of the population aged 20 to 60
years and a declining share of children.
This age structure change is occurring more rapidly in many Arab countries, than more developed
and aged societies elsewhere in the world, for which this change was spread over a longer period.
Therefore, families and concerned societies will have less time to adjust.48 The speed of this age
structure transition will vary from one country to another according to the demographic dynamics
(fertility, mortality, and migration) of the corresponding population. This chapter uses the same
categorization of countries as chapter one to shed light on the future challenges that could undermine
older persons’ prospects of ageing with dignity, and it pays particular attention to Arab countries
facing conflict and humanitarian crises where the dependency and vulnerability of older persons is
further exacerbated.
This chapter explores the prospects of ageing with dignity in the horizon of 2030, the target year to
achieve the Sustainable Development Goals (SDGs), and beyond. More specifically, it builds on
Chapter 1’s presentation of current demographic trends and future prospects to provide an evidence-
based projection of the needs of older persons in the Arab region by 2030 and 2050. It begins with
the caveat that population prospects necessarily come with an extent of uncertainty and explains the
nuance of the projections used in this analysis of the population forecast on the ageing process in
Arab countries. Afterwards, it examines possible challenges that an increasing number of older
persons will face in terms of health service needs, social protection and family care, using both
quantitative and qualitative evaluative approaches. Although this analysis is based on hypotheses,
these projections elucidate the possible consequences, and therefore indicate the need to take the
appropriate measures to prepare for needs of all segments of the population and to ensure that older
persons are not left behind. In this spirit, the chapter proposes policy recommendations to enable older
persons to age in dignity.
A- Demographic scenarios and Arab ageing
There is inherent uncertainty in population projections, specifically uncertainty surrounding the
projected trends of fertility, mortality and net migration. In UN projections, only fertility levels are
different in the three projections variants: low, medium and high (see Annex 1). Neither mortality nor
migration variables change across the projections.
Not only are fertility rates important to determining population ageing, but also when the high fertility
rates occurred. The projected future size of the elderly population by 2030 depends only on fertility
rates prior to 1970 and 1990, since those born before these years will be over 60 years of age by 2030
and 2050, respectively. Therefore, future levels of fertility will not affect the size of the older
population by 2030 or 2050.
48 For example, to reform the pension schemes, to adapt health care system and accommodate to labour supply change, senior consumption and saving.
70
Table 1 shows that, for all Arab countries together, by 2030, the population 60 years and older and
75 years and older would be respectively about 49.6 million and 10.5 million, irrespective of the
assumed fertility trends (low, medium or high variant).4950 These sizes represent respectively slightly
more than 1.8 and 1.7 times the corresponding numbers in 2015, which indicate an ageing boom
driven mainly by high fertility in the past.The effect of declining mortality rates between 2015 and
2030 will not have as much as an impact as high fertility in the past. Even with constant mortality
rates, the number of people over 60 years of age is projected to reach 47.7 million. However, by 2050,
declining mortality rates will start to have significant impact, particularly for persons aged 75 years
and over.
2015 2030 2050 2015 2030 2050
Medium Variant 26826 49594 102087 5915 10477 27096
High Variant 26826 49594 102087 5915 10477 27096
Low Variant 26826 49594 102087 5915 10477 27096
Constant-Mortality 26826 47753 89907 5915 9601 20508
Table 1: The Arab Region Population (in Thousands) 60 Years and Older and 75 Years and
Older According to Different UN Projection Scenarios
Projection Variants Country
Arab Countries
Source: The United Nations World Population Prospects (2017)
60+ 75+
The impact of mortality decline depends on whether it occurs mainly at young or old age. During the
first stages of demographic transition, mortality decline usually occurs at young ages, particularly at
infant and child-age. Declining mortality of infants and children often makes the population younger
by increasing the number of young persons living in the population. Later in demographic transition,
mortality rates at young ages are already low, and declining mortality of adults and persons of older
age begin to contribute to population ageing as more adults and older persons are living in the
population, in relative as well as absolute terms.
The fertility rates from 2015 to 2050 will not affect the number of older persons by 2030 or 2050;
yet, they will affect the proportion of older persons within the population (table 2). The more rapid
fertility decline combined with reduced mortality, the higher the percent of population 60 years and
older or 75 years and over, especially over the long-term. Countries in the late stage of demographic
transition, like Lebanon and Tunisia, are experiencing increases in the relative numbers of older
persons sooner than those at midst or beginning of demographic transition, such as Djibouti and
Comoros (see Annex 3 for individual country data).
49 Annex 2 presents the absolute numbers of the projected population 60 years and older and 75 years and over
according to the 2017-UN projections scenarios, for each Arab country in 2015, 2030 and 2050.
50 The size of the population over age 75 is indicated here, as well as over age 60, to highlight the size of the population with increased levels of dependence and potential vulnerability.
71
2015 2030 2050 2015 2030 2050
Medium Variant 6.7 9.5 15.1 1.5 2 4
High Variant 6.7 9.2 13.6 1.5 1.9 3.6
Low Variant 6.7 9.9 16.8 1.5 2.1 4.5
Country Projection Variants
Arab
Countries
Table 2: Proportion of the Population 60 Years and Older and 75 Years and Older by
UN Projections Scenarios for All Arab Countries
Source: The United Nations World Population Prospects (2017)
% 60+ % 75+
Sensitivity of ageing to demographic scenarios, examples from the Wittgenstein Centre
for Demography and Human Capital (WCDHC)
While the scenarios originating from the United Nations 2017 World Population Prospects
(WPP) used in this report focus principally on varying hypotheses about fertility, it is also
possible that the other demographic determinants, such as mortality and migration, may show
different trends in the future than as predicted and that their deviation from projections can
affect the extent and the pace of population ageing.
The WCDHC has developed projections to demonstrate different possible population realities
for the future. The results of these projections show very little difference in the share of the
older population aged 60 and over in Arab countries by 2030, similarly to projections by the
UN WPP. However, by 2050, the WCDHC predicts that the proportion of this age group will
vary quite significantly (see Table 2) by scenario. Of the seven scenarios developed by the
Wittgenstein Centre, the findings for three of them are highlighted below as useful comparison
to the projections presented otherwise throughout this report.
The Sustainability Scenario: Assuming a future in which Arab countries are moving toward
a more sustainable and developed status, the share of population in Arab countries aged 60 and
over would be 23 per cent in 2050. This scenario predicts the highest share of all the scenarios.
In this scenario, on average, all countries reach below replacement fertility and many reach
extremely low fertility (below 1.5 children per woman) by 2050. The average life expectancy
for both sexes is predicted to be above 85 years in most countries, except in some least
developed countries, such as Somalia, Mauritania and Comoros, where it would still be under
70 years.
Continuation Scenario: In the continuation scenario, trends typical of recent decades
continue, the. The share of the population 60 years and over is presently and is held constant
at 18 per cent -- this is about 4 per cent less than in the previous scenario. This middle of the
road scenario recognizes some progress toward achieving development goals, but also
considers that the development of low-income countries is uneven, with some countries
making good progress, while others do not. As a result, fertility is projected to be at or just
below replacement level in 2050 in most Arab countries, except Somalia and Yemen where
the total fertility is projected to be above 2.5 children. The life expectancy for both sexes is
projected to be between 80 and 85 years of age in most Arab countries, yet lower in the Arab
low-income countries.
72
Fragmentation Scenario: The fragmentation scenario imagines a world with disparate
regions characterized by extreme poverty, pockets of moderate wealth, and many countries
struggling to maintain living standards for rapidly growing populations. According to this
scenario, the share of population aged 60 and over in Arab countries would be the lowest of
all scenarios, around 15 per cent. The low proportion of older persons is mostly due to the
relative increase of the young population due to a reverse trend in fertility, with fertility
increasing again in many countries where it had already reached low levels. In Lebanon, for
example, the fertility would be predicted to increase to 2.2 children per woman by 2050, when
it was at a low level of 1.7 in 2010-2015, according to the United Nations 2017 WPP). The
decline would be more moderate in countries that presently have high fertility. At the same
time, the gains in life expectancy would be moderate – at most four years over four decades.
Some countries, including Djibouti and the Sudan, would even be predicted to regress and to
have lower life expectancy than in 2015.
It is worth noting that these scenarios are also diverging in considering the effects of migration
on population ageing in Arab countries. Migration will also have some influence, although at
a lower scale compared to fertility and mortality,. The fragmentation scenario assumes that
traditional receiving countries of migrants, such as European countries or the United States,
will restrict migration inflows in general and hence affect migrants coming from Arab
countries. On the other hand, the continuation and sustainability scenarios predict that there
will be even more opportunities for the populations of Arab countries to become economic
migrants in a more liberal world.
At the individual country level (Annex 7), the projections show that the differences between
these scenarios are particularly large for some countries, particularly those where ageing is
quite advanced already. For example, in Tunisia the fragmentation scenario predicts a scale of
25 percent of the population aged 60 in 2050 and over, whereas the sustainability scenario
predicts 35 per cent. A similar pattern of different projections applies to Morocco. On the
contrary, in slower ageing countries, the differences between the scenarios tend to be smaller.
For example, the first two scenarios predict a range of 6-11 per cent share of population aged
60 and older in Somalia by 2050.
Besides the increase in the share of elderly population in Arab countries in the future, these
scenarios demonstrate overall that a more sustainable Arab region will most likely also bring
an increased proportion of older population.
Figure 1 illustrates for selected countries how different demographic scenarios (different pace of
fertility decline) will transform the age-sex population pyramid by 2030. Morocco will likely see
dramatic changes in its age structure. Except for the high variant projections, this country will start
to have an inverted age pyramid, with more older persons than younger persons in the population. In
contrast, Yemen will still have a young population without noticeable transformation of its age
structure. In all selected countries, the shape of the age pyramid of the medium variant and that
corresponding to the variant with constant mortality will practically be similar. Since only mortality
assumptions differ in these two variants, this means that mortality will likely not have an important
effect on age structure of these Arab countries by 2030.
73
Figure 1: Age-sex pyramid of select countries in 2015 and 2030 according to the low, medium, high
and constant-mortality variants of UN-projections
Morocco
2000 1500 1000 500 0 500 1000 1500 2000
05
10152025303540455055606570758085
90+
2015
Males Females
2000 1500 1000 500 0 500 1000 1500 2000
05
10152025303540455055606570758085
90+
2030: Medium variant
Males Females
2000 1500 1000 500 0 500 1000 1500 2000
05
10152025303540455055606570758085
90+2030: High variant
Males Females
2000 1500 1000 500 0 500 1000 1500 2000
05
10152025303540455055606570758085
90+
2030): Low variant
Males Females
74
Jordan
2000 1500 1000 500 0 500 1000 1500 2000
05
10152025303540455055606570758085
90+
2030: Constant-mortality
Males Females
800 600 400 200 0 200 400 600 800
05
10152025303540455055606570758085
90+
2015
Males Females
800 600 400 200 0 200 400 600 800
05
10152025303540455055606570758085
90+
2030: Medium variant
Males Females
75
United Arab Emirates
800 600 400 200 0 200 400 600 800
05
10152025303540455055606570758085
90+
2030: High variant
Males Females
800 600 400 200 0 200 400 600 800
05
10152025303540455055606570758085
90+
2030: Low variant
Males Females
800 600 400 200 0 200 400 600 800
05
10152025303540455055606570758085
90+
2030: Constant-mortality variant
Males Females
76
1500 1000 500 0 500 1000 1500
05
10152025303540455055606570758085
90+
2015
Males Females
1500 1000 500 0 500 1000 1500
05
10152025303540455055606570758085
90+
2030: Medium variant
Males Females
1500 1000 500 0 500 1000 1500
05
10152025303540455055606570758085
90+
2030: High variant
Males Females
1500 1000 500 0 500 1000 1500
05
10152025303540455055606570758085
90+
2030: Low variant
Males Females
1500 1000 500 0 500 1000 1500
05
10152025303540455055606570758085
90+
2030: Constant-mortality variant
Males Females
77
Yemen
3000 2000 1000 0 1000 2000 3000
05
10152025303540455055606570758085
90+
2015
Males Females
3000 2000 1000 0 1000 2000 3000
05
10152025303540455055606570758085
90+
2030: Medium variant
Males Females
3000 2000 1000 0 1000 2000 3000
05
10152025303540455055606570758085
90+
2030: High variant
Males Females
3000 2000 1000 0 1000 2000 3000
05
10152025303540455055606570758085
90+
2030: Low variant
Males Females
78
While migration does not play a large role as a determinant of population ageing in the Arab region,
migration in general can affect the ageing of a population. Net migration increases the size of the
working-age population of receiving countries, as usually only small shares of migrants are aged over
60 years. In fact, migration’s effect on ageing largely depends on whether it is temporary or
permanent. When it is temporary, return migration of migrants at older ages following retirement may
occur, meaning that the majority of migrants continually represent working-age individuals. In this
case migration may delay ageing, but not prevent it or contribute to it. However, the degree to which
the ageing of migrants delay the ageing of the population depends on the rate of growth of net
migration over time.
For example, more migrants are living in the GCC countries today than any other Arab subregion.
However, these countries’ immigration policies allows only for “circular” migration. Hence, older
migrants will be replaced by new, young ones. As a result, migrants are unlikely to contribute
significantly to ageing in these countries; rather they may postpone ageing given that they decrease
the ratio of elderly to the total population. Likewise, migrants are unlikely to be an important
determinant of ageing in Arab sending countries. Return migration of Arab migrants is not significant
enough to affect the total demographic growth of these countries or of the share of older persons. For
example, according to the 2004 General Population and Housing Census of Morocco, a former
emigration country, the total stock of return migrants barely reaches 165,416 of whom 36,888 (22.3
per cent) are 60 years old and over.51 Compared to 2,375,623 persons enumerated by the census,52
return migrants represent no more than 1.6 per cent.
51 Mghari, M. (2010) “Migration de retour au Maroc”. Les Cahiers du Plan. N°29-mai-juin 2010. Pp : 4-44.
52 HCP (2006) RGPH 2004: caractéristiques démographiques et socio-économiques de la population.
3000 2000 1000 0 1000 2000 3000
05
10152025303540455055606570758085
90+
2030: Constant-mortality varainat
Males Females
79
The impact of armed conflict on population age structures
“An estimated 7.5 million people are displaced within Syria, and more than 4 million refugees have fled to neighboring
countries including, 1.2 million Syrians refugees in Lebanon registered with the United Nations High Commission for
Refugees”.”53
“The displacement, in absolute terms and relative to the host population, has overwhelmed some of these neighboring
countries. For example, Lebanon, a country of just over four million people, registered its millionth Syrian refugee shortly
after the survey in Lebanon was concluded [In 2013-2014].”54
In such situationsituations, evidence suggests that these forced movements will have an impact on population age
structure. As shown in Chapter two, displacement patterns in the Syria crisis have demonstrated that older persons
generally do not flee their home country as often or as easily as young people do. There is an urgent need for more data
to assess the demographic as well as medical, social and economic consequences of conflict on older persons.
B- Education levels of the elderly by 2030/2050: an enabling factor that needs improvement
Education is necessary for the social and cultural integration of elderly individuals. It “enables
individuals to develop new skills, strengthen social networks, and feel more able to deal with life’s
challenges”55. Future older people must be given more chances to learn in order to have more
opportunities to contribute to society.
New population projections by age, sex, and level of educational attainment56 reveal how young,
more educated cohorts will replace older cohorts with lower levels of educational attainment in the
coming decades. The following education categories were considered in this analysis:
• No education: never been to school;
• Primary: some primary, complete primary, incomplete lower secondary;
• Secondary: Completed lower secondary to incomplete first level of tertiary;
• Post-secondary: Completed first level of tertiary or higher.
53 UNHCR. 2015. Syria Regional Refugee Response - Inter-agency Information Sharing Portal [Online]. Geneva:
UNHCR. Avalable in: http://data.unhcr.org/syrianrefugees/regional.php . Cited by.Blanchet et al. (2016) “Syrian refugees
in Lebanon: the search for universal health coverage”
Conflict and Health 201610:12 https://doi.org/10.1186/s13031-016-0079-4© [accessed in 06/12/2017] 54 2014 Syrian Arab Republic Humanitarian Assistance Response Plan (SHARP), 2013.
http://reliefweb.int/sites/reliefweb.int/files/resources/2014_Syria_SHARP.pdf. Cited by Moazzem Hossain, S. M. and all
(2016) “Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys”.
Conflict and Health201610:26 https://doi.org/10.1186/s13031-016-0093-6 [accessed in 06/12/2017].
55 Friebe, J. and Schmidt-Hertha, B. (2013) “Activities and barriers to education for elderly people”. Journal of Contemporary Educational Studies 1/2013 http://www.sodobna-pedagogika.net/wp-content/uploads/2013/03/Friebe-Schmidt1.pdf [accessed on 19/09/2017]
56 These projections were done for 195 individual countries with a time horizon to 2060. See: Lutz W, Butz W, and KC
S, eds. 2014 World Population and Global Human Capital in the 21st Century, Oxford University Press 2014. www.wittgensteincentre.org/dataexplorer/
80
Table 5 presents the results of the medium scenario of future trends in the educational levels of the
older population for all Arab countries together.57 This scenario is based on historical educational
trends and implies sustained effort in increasing education attainment throughout youth and young
adult ages. It confirms that improvement in educational composition of the elderly population is
already pre-programmed into the age structure. “The younger, better-educated cohorts will inevitably
become older and replace the older.”58 Improvement of the average level of education is predicted to
be true for both females and males. In 2015, 44.5 per cent of older male adults are reported to have
no education. By 2030, only a quarter (24.9 per cent) are expected to have no education, and by 2050,
this number will be only 11.3 per cent.
Considering the proportion of older persons who have at least secondary level education, it will
include 50 per cent of future older males in 2030 and 68.2 per cent in 2050, while only three out of
ten (30.4 per cent) had secondary level or higher in 2015. While it is expected that males will likely
be better educated in the future, at least half will not reach secondary level by 2030 and three out of
ten will not reach secondary level by 2050.
Advances in technology over the decades is predicted to both assist older adults and to require more
knowledge from them. Many technologies have been developed that might help older adults age in
dignity while monitoring their health and safety (e.g. mobile devices, wearable gadgets, Internet-
based technologies, cars that drive themselves, telemedicine or video-call doctors’ visits, remote
patient monitoring, etc.). However, often the use of such technology requires a satisfactory level of
technical skills or education59.
Women aged 60 and over will likely continue to be behind in terms of education, compared to men.
Almost three quarters of females had no education in 2015. This is predicted to improve slightly as
only more than half of them will have no education in 2030 and more than a fifth in 2050.
Nevertheless, this is still double the number of males that will have no education over the same period.
Almost seven out of ten (71.3 per cent) older females are expected to have less than secondary level
of education by 2030, and more than four out of ten (42.1 per cent) by 2050.
However, other scenarios for the year 2030 show virtually identical results for educational attainment
level of men and women above age 55. Accordingly, a high proportion of older Arab people may still
be deprived of their right to education in 2030, women much more than men. Countries should take
appropriate measures to improve the level of education while reducing the gender gap, such as the
strengthening of informal education of present and future old persons.
57 This is the middle of the road scenario that can also be seen as the most likely path for each country. It combines for
all countries medium fertility with medium mortality, medium migration, and the Global Education Trend (GET)
education scenario.
58 Wolfgang Lutz and Sergei Scherbov (2004) “Probabilistic Population Projections for India with Explicit
Consideration of the Education-Fertility” International Statistical Review, Vol. 72, pp. 81-92, International Statistical Institute reprinted in http://pure.iiasa.ac.at/14782/1/Sergei-web-total.pdf
59 Wendy A. Rogers, Aideen J. Stronge, Arthur D. (2005) “Technology and Ageing Risk”. Reviews of Human Factors and Ergonomics. Volume: 1 issue: 1, page(s): 130-171 http://journals.sagepub.com/doi/abs/10.1518/155723405783703028
81
Total No Education Primary Secondary Post-Secondary Total No Education Primary Secondary Post-Secondary
2015 100 44.5 25.1 19.2 11.2 100 74.1 13.9 8.2 3.8
2030 100 24.9 25.0 33.9 16.2 100 51.7 19.6 20.4 8.4
2050 100 11.3 20.4 46.6 21.6 100 22.8 19.3 38.2 19.7
YearMales Females
Table 3: Population by Education Level (in %) of the Arab Region
Source: Author's calculation from: Lutz W, Butz W, and KC S, eds. 2014 World Population and Global Human Capital in the 21st Century, Oxford
University Press 2014. www.wittgensteincentre.org/dataexplorer/
However, this average situation masks wide dispersion among countries. Some are quite advanced in
this respect, while others lag far behind as shown in figures 2 to 4 and in Annex 4. In 2015, Sudan,
Comoros, Morocco, Somalia, Mauritania had the highest proportions of old people with no education
while Qatar, Kuwait, Oman were the countries with the smallest proportions of males with no
education. In 2030, then in 2050, new cohorts reach age 60 and over. Depending on the past efforts
of school enrollment, and perhaps due to the sensitivity to data quality of the base year, this ranking
is somewhat changing. In 2030, Sudan, Morocco, Somalia, followed by Mauritania and Comoros are
expected to have the highest proportions of elderly with no education. In contrast Qatar, Oman,
Lebanon followed by Palestine will likely have the smallest percent of “no education”. In 2050,
Sudan, Somalia, Morocco then Mauritania followed by Comoros are projected to have the highest
proportion of people without education level while Qatar, U.A.E, Lebanon, Bahrain then Kuwait are
expected to have the smallest proportion of this category of the elderly.
Especially in the future, the ability to read and write would not be sufficient to guard against
vulnerability. One has to get higher levels of education to have benefits for the health and economic
status. As pointed out by UN-population Division, “improvements in the educational attainment of
the older population may also alleviate any cultural gap between generations that may have widened
over the past century. Particularly in the case of the less developed regions, where illiteracy is
generally high at all ages but especially among older groups, higher levels of literacy are likely to
substantially affect the interests, needs and abilities of future older generations, and improve the
quality of their lives”60. We have to admit that even by 2030, and if no additional measures are taken,
almost half of men and slightly more than 65% of women 60 years and over of Arab countries, will
not likely reach secondary level. This expected average situation hides wide differentials among
countries as figure 2 shows. For men, the fifth countries with the expected highest improvement in
elderly education level are Bahrain, Jordan, UAE, Saudi Arabia and Lebanon and. For women, they
are UAE, Bahrain, Kuwait, Lebanon and Qatar. In contrast, the fifth countries with the expected
smallest proportion of elderly having at least secondary level of education will likely be Sudan,
Comoros, Djibouti, Morocco and Mauritania for men; and Sudan, Somalia, Comoros, Djibouti,
Morocco and Mauritania. This ranking will likely remain more or less the same by 2050 as shown in
figure 4 (for 2050).
60 UN Department of Economic and Social Affairs Population Division (2001) “World Population Ageing: 1950-2050” ST/ESA/SER.A/207 http://www.un.org/esa/population/publications/worldageing19502050/ [accessed on 26/10/2017]
82
Figure 2: Males and females aged 60 and over by educational level (%): 2015
Source: author conception from: Lutz W, Butz W, and KC S, eds. 2014 World Population and Global Human Capital in
the 21st Century, Oxford University Press 2014. www.wittgensteincentre.org/dataexplorer/
0% 20% 40% 60% 80% 100%
Qatar
Kuwait
Oman
YemenU. A. E
Lebanon
Bahrain
Palestine
Jordan
Syria
Iraq
Saudi A.
Tunisia
Algeria
All Arab countries
EgyptDjibouti
Libya
Mauritania
Somalia
Morocco
Comoros
Sudan
Figure 2A: Males 60 Years and Older by Education Level (%):
2015
No Education Primary
Secondary Post Secondary
0% 20% 40% 60% 80% 100%
QatarKuwait
U.A.ELebanon
YemenOman
BahrainJordan
SyriaIraq
PalestineDjibouti
Arab countriesEgypt
AlgeriaSaudi A.
MauritaniaTunisia
LibyaMorocco
SudanSomalia
Comoros
Figure 2B: Females 60 Years and Older by Education Level
(%): 2015
No Education Primary
Secondary Post Secondary
83
Figure 3: Males and females aged 60 and over by educational level (%): 2030
Source: author conception from: Lutz W, Butz W, and KC S, eds. 2014 World Population and Global Human Capital in
the 21st Century, Oxford University Press 2014. www.wittgensteincentre.org/dataexplorer/
0% 50% 100%
Qatar
Lebanon
Yemen
Saudi A.
Bahrain
Syria
Tunisia
All Arab countries
Djibouti
Comoros
Somalia
Sudan
Figure 3A: Males 60 Years and Older by Education
Level (%): 2030
No Education Primary
Secondary Post Secondary
0% 20% 40% 60% 80% 100%
Qatar
Lebanon
Kuwait
Oman
Palestine
Syria
Algeria
All Arab countries
Egypt
Comoros
Morocco
Sudan
Figure 3B: Females 60 Years and Older by Education Level
(%): 2030
No Education Primary
Secondary Post Secondary
84
Figure 4: Males and Females Aged 60 and Over by Educational Level (%): 2050
Source: Author’s conception from: Lutz W, Butz W, and KC S, eds. 2014 World Population and Global Human Capital
in the 21st Century, Oxford University Press 2014. www.wittgensteincentre.org/dataexplore.
C- Health care
Indisputably, population ageing will increase the amount of ill-health and disability. Chronic
conditions, multi-morbidities, and cognitive impairments will become more common, which is why
ageing constitutes a challenge to the health care system and an increasing pressure for families, and
especially for women, who have to balance care with other responsibilities, like work. In order to
meet this increasing demand of physical and financial support, health and care systems and support
for unpaid carers will need adaptations.
Non-Communicable Diseases 61
In order to have an idea of the extent of the ageing impact on health system, we can examine the
number of non-communicable diseases in the future, taking into consideration medium variant of the
UN demographic projections. Data for individual countries and for the entire Arab countries are not
available, only data on deaths due to NCD from the WHO publication on the burden of diseases are
accessible. Thus, projections of the number of non-communicable diseases are based on a “rough”
macro approach, essentially using the proportions of the population with non-communicable diseases
(NCD) by age group (respectively 50-69 and 70+) in 2015 and in 2030 for MENA countries and the
61 Non-communicable diseases is used interchangeably with chronic diseases and refers to cardiovascular diseases,
diabetes, chronic respiratory diseases, cancers, mental illnesses and injuries.
0% 20% 40% 60% 80% 100%
Lebanon
Saudi A.
Yemen
Algeria
Tunisia
Iraq
Syria
Comoros
Egypt
Morocco
Mauritania
Sudan
Figure 4A: Males 60 Years and Older by Education Level
(%): 2050
No Education Primary
Secondary Post Secondary
0% 20% 40% 60% 80% 100%
Lebanon
Bahrain
Jordan
Yemen
Kuwait
Iraq
Syria
Comoros
Egypt
Libya
Mauritania
Sudan
Figure 4B: Females 60 Years and Older by Education Level
(%): 2050
No Education Primary
Secondary Post Secondary
85
population projections of people 60-69 years and 70 years and older. For the sake of the exercise, it
is assumed that the MENA countries and Arab countries don’t differ significantly in terms of the
share of NCD, and that the share for persons 50-69 years old is the same as for persons 60-69 years
old. Hence, numbers of people with NCD for Arab countries are calculated by applying percentages
of people with NCD in MENA for the corresponding age groups and years as indicated in table 4.
50-69 Years 70+ Years
73762561 17576480
739 331 1152872
123297026 32714733
1123505 1954709
2015 (3) A1/B1 1 6.56
2030 (4) A2/B2 0.91 5.98
60-69 years 70+ years
2015 (5) 16256 10569
2030 (6) 29936 16732
2015 (3) x (5) 163 693
2030 (4) x (6) 273 1000
Table 4: Estimates of the Number of Non-Communicable Diseases in Arab Countries*
Source: Author’s calculation for illustration purpose based on: WHO; 2013 Global health estimates summary
tables: projection of deaths by cause, age and sex, by World Bank Income Group and WHO Region,
(http://www.who.int/healthinfo/global_burden_disease/en/)
Note: *Assuming the same rates of non-communicable diseases as in MENA countries: 2015 and 2030
Non-communicable diseases (A2) in 2030
Rate of non-communicable diseases (%)
Arab Countries
Population (in thousands)
Population of Arab country with non-
communicable diseases by age (in thousands)
MENA Region
Population (B1) in 2015
Non-communicable diseases (A1) in 2015
Population (B2) in 2030
It follows that the number of non-communicable diseases in Arab countries among 60 years and older would be 856 000 cases in 2015 and 1 273 000 cases in 2030, which is a variation of 48.7%. This result is consistent with the findings of many studies on the trend of this phenomenon. For example, “It is estimated that, overall, 47 percent of the region’s burden of disease is due to NCDs and by 2020 this is anticipated to rise to 60 percent (Khatib, 2004), yielding one of the world's greatest increases in the absolute burden of NCDs and their risk factors (Motlagh et al., 2009). Over 66 percent of NCD-related deaths occur in individuals above 60 years of age.”
This change from a burden of disease dominated by mortality from infectious causes to degenerative or chronic causes, called epidemiological transition (Omran 1971), is compressed, for Arab countries, into a shorter time frame than that experienced historically in high-income countries. As a result, Arab countries not only have to deal with their current burden of infectious diseases still prevailing, but also with this growing burden of chronic diseases.
WHO has already drawn attention to the rapid growth of chronic diseases, urging countries to provide leadership to address chronic diseases by taking the necessary interventions towards prevention and risk reduction. “Common, modifiable risk factors underlie the major NCDs. They include tobacco, harmful use of alcohol, unhealthy diet, insufficient physical activity,
86
overweight/obesity, raised blood pressure, raised blood sugar and raised cholesterol.[…] A series of low-cost, high-impact actions can be implemented using existing knowledge”62.
Other studies have also called attention to the need for more training of professionals in the health field to cope with their shortage. For instance, Hajjar and All, having noticed an important increase of cancer in the Middle East, have pointed out63 that “the focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services”.
The need for professionals is urgent in Arab countries, in particular when it concerns the elderly population with comorbidity. Geriatrics specialty in this regard has an important role. As Abaid underlined “One of the most important areas in caring for the elderly is to focus on the need for geriatric and gerontological education and training for a wide range of health professionals and para-professionals who provide care to elderly persons, in order to meet the future demand for quality long-term care services (9-12).”64 However, geriatrics is a relatively new branch of medicine that has only recently started getting attention in most of the region. Egypt and Lebanon have taken the lead in advancing training and research this respect65.
62For more detail, see: WHO. Global Health Observatory (GHO) data. http://www.who.int/gho/ncd/en/ [accessed in
07/12/2017]
63 Hajjar, R. R. and All (2013) “Prevalence of ageing population in the Middle East and its implications on cancer incidence and care” Ann Oncol. 2013 Oct; 24(Suppl 7): vii11–vii24.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767158/
64 Abyad, A. (2004) “From the Editor: Geriatrics in the Middle East” Volume 1,Issue 1 http://www.me-jaa.com/content0.htm [accessed on 26L09/2017]
65 For an overview on the experience of Egypt, see: Sibai AM, Rizk A, Kronfol KM (2014). Ageing in the Arab Region: Trends, Implications and Policy options. The United Nations Population Fund (UNFPA), Economic and Social Commission of Western Asia (ESCWA) and the Center for Studies on Ageing (CSA). Beirut, Lebanon. http://csa.org.lb/cms/assets/csa%20publications/unfpa%20escwa%20regional%20ageing%20overview_full_reduce
87
Lebanon: Ain Wazein Hospital with the American University of Beirut and the Lebanese University
This collaborative program between a tertiary care hospital in a rural area and its affiliated academic nursing
home with two universities in Lebanon provides on-site training in geriatrics for three internal medicine
residents from each university every month, as well as two geriatric fellows and 12 master’s degree students.
In addition, those in the Bachelor of Science nursing program may enter a master’s program in gerontology.
Egypt: Ain Shams University
The Geriatrics and Gerontology Department of the University’s Faculty of Medicine is the first department in
Egypt to offer a master’s degree and medical degree in geriatric medicine connected to a specialized residency
program and clinical training course. Since 2002, all of the university’s medical graduates (approximately
700–1000 annually) have studied geriatric medicine through this new program. As a result, a large number of
qualified geriatric specialists and consultants are increasingly available in Egypt and other Arab countries.
Source: WHO (2016) Health workforce and population ageing
http://www.who.int/ageing/publications/health-workforce-ageing-populations.pdf
According to Sibai & All “Overall, there is a serious lack of geriatricians in many of the Arab
countries. Except for Bahrain (one geriatrician for every 8,250 persons aged 65 or over) and Lebanon
(one for every 20,000 persons aged 65 or over), the number of geriatricians does not exceed one for
every 100,000 older persons in most Arab countries. This is compared to around one geriatrician for
every 5-7000 older persons in the United States (Yousufzai, 200766)”67. Despite the level of this ratio,
the American Geriatrics Society argues that, ideally, the United States should have one geriatrician
for every 700 people 65 and older.
Regardless of the ideal ratio, practically all Arab countries lack local geriatricians or physicians
trained in geriatrics, and they won’t be readily available in the near future, since medical training
takes several years. For example, a rapid calculation for Morocco (table 7) to estimate the demand of
these physicians, assuming the ratio of old people per geriatrician from 2015 remains constant –
already very low – shows that the number of geriatricians should almost double by 2030. If Morocco
wants to match the efforts of France in this area, it should already have almost 22 times the number
of geriatricians it had in 2015 and it should have about 40 times that in 2030, a non-realistic scenario
given the number of years needed to train a specialist. Hence, it’s urgent to consider alternative
solutions, like training all health professionals in geriatric care and fostering immigration of
specialized physicians. Although this is a hypothetical scenario, it highlights the future challenges in
terms of health care for the elderly and the need to strengthen a “Minimum Geriatric Competencies”
initiative to all health professionals.
66 Yousufzai S (2007). The Future of Geriatric Medicine A pending healthcare crisis? Issues Berkeley Medical Journal at UC Berkley. Cited in Sibai and All (2014) see footnote 10.
67 Sibai AM, Rizk A, Kronfol KM (2014). Ageing in the Arab Region: Trends, Implications and Policy options. The United Nations Population Fund (UNFPA), Economic and Social Commission of Western Asia (ESCWA) and the Center for Studies on Ageing (CSA). Beirut, Lebanon. P: 41. http://csa.org.lb/cms/assets/csa%20publications/unfpa%20escwa%20regional%20ageing%20overview_full_reduce
88
Year
Number of Geriatric Physicians Needed to
Maintain the 2015 Elderly to Geriatric
Physician Ratio
Number of Geriatric Physicians Needed to
Match the 2015 Elderly to Geriatric Physician
Ratio in France*
2015 16 367
2030 (Medium Variant) 30 681
Table 5: Number of Geriatric Physicians Needed in Morocco
Note: * http://www.data.drees.sante.gouv.fr
Source: Author’s calculation based on the medium variant of the UN World Population Prospects )2017( and on HCP Annuaire Statistique 2015.
The flagrant lack of geriatric professionals is by no means the only handicap to the proper medical
care of the elderly today and in the near future. Deficits in universal health protection are the principal
obstacle to health well-being of the population in general, and of older persons in particular, as shown
by table 5. The percent of population without legal coverage is very high in Mauritania, Somalia,
Sudan, the State of Palestine, Yemen and Saudi Arabia. Even though the available statistics aren’t
recent and the current situation may be better, table 6 shows the extent of the medical deficit that
could still be faced by Arab countries, and the burden it creates in individuals, especially older
persons. Out-of-pocket expenditure as a percentage of total health expenditure ranges from 10.9% in
Oman to 59.2% in Egypt. In this respect, many may not have access to their right to health services
in the future if no significant efforts are made to strengthen health systems to achieve universal health
protection.
Total Year* Total Year*
Algeria 14.8 2005 19.7
Bahrain 0 2006 17.6
Egypt 48.9 2008 59.2 2009
Iraq 26.1 2006
Jordan 25 2006 25.1 2002
Kuwait 0 2006 17.5
Lebanon 51.7 2007 44.4
Libya 0 2004 30
Mauritania 94 2009 33.2 2004
Morocco 57.7 2007 57.2 2000
Oman 3 2005 10.9
Qatar 0 2006 16
Saudi Arabia 74 2010 20
Somalia 80 2006
State of Palestine 83.8 2004
Sudan 70.3 2009
Syrian Arab Republic 10 2008 54
Tunisia 20 2005 35
United Arab Emirates 0 2010 19.5
Yemen 58 2003 73.8 2005
Country
Legal Health Coverage
Deficit as a Percentage of
Population without Legal
Coverage
Table 6: Estimates of Deficits in Universal Health Protection and
Out-of-Pocket Expenditure
Source: ILO (International Labour Office). Social Health Protection Database, Statistical
Annexes
Out-of-Pocket Expenditure
as a Percentage of Total
Health Expenditure
89
In particular, fragile and conflict-affected states (FCAS) have weak institutional capacities, leading
to weak health systems that
don’t meet the population’s
health needs. Typically,
“Beyond access to basic
services, including primary
health care and education for
school-aged children, many
refugees fleeing Syria have
serious health care needs due
to, amongst other things, pre-
existing chronic conditions
and injuries suffered during
the conflict”68.
In the future, due to the
destroyed health facilities,
weakening of health system,
chronic and emotional
conditions and injuries
suffered during the conflict,
in addition to the loss of
personal sources of the
income, destroyed homes and
death of family members, the elderly, much more vulnerable and frail, would need the maximum of
support years after the end of armed conflict.
Disability
Increase in chronic health conditions will influence the nature and prevalence of disability, which is
why ageing often leads to an increase of the number of people at risk for disability. These conditions
will inevitably increase the demand for health services, the medical expense and the burden of long-
term care. The World Bank69 points out that “increasingly, disabilities associated with chronic
conditions and both intentional and unintentional injuries are becoming a major cause of long-term
disability in MENA countries. […]Disabilities add to social costs due to the high cost of treatment
and care, and also have a negative impact on labor productivity. Much of these costs could be avoided
68See: Coutts A, Fouad FM, Abbara A, Sibai AM, Sahloul Z, Blanchet K. Responding to the Syrian health crisis: the need
for data and research. Lancet Respir Med. 2015;3:e8–9.
Maziak W, Rastam S, Mzayek F, Ward K, Eissenberg T, Keil U. Cardiovascular health among adults in Syria: a model
from developing countries. Ann Epidemiol. 2007;17:713–20.
Taleb Z, Bahelah R, Fouad F, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition.
Int J Public Health. 2014;60:63–72.
All are cited in: Blanchet et al. 2016. Syrian refugees in Lebanon: the search for universal health coverage Conflict and
Health201610:12 https://doi.org/10.1186/s13031-016-0079-4.
69 World Bank (2005) A note on disability issues in the Middle East and North Africa. Human Development Department Middle East and North Africa Region.
A study on health status and health needs of older refugees from Syria in Lebanon
Objective
To characterize the physical and emotional conditions, dietary habits, coping practices, and living
conditions of this elderly population arriving in Lebanon between March 2011 and March 2013.
Methods
A systematic selection of 210 older refugees from Syria was drawn from a listing of 1800 refugees
over age 60 receiving assistance from the Caritas Lebanon Migrant Center (CLMC) or the
Palestinian Women’s Humanitarian Organization (PALWHO). CLMC and PALWHO social workers collected qualitative and quantitative information during 2013.
Results
Two-thirds of older refugees described their health status as poor or very poor. Most reported at least one non-communicable disease, with 60% having hypertension, 47% reporting diabetes, and
30% indicating some form of heart disease. Difficulties in affording medicines were reported by
87% of participants. Physical limitations were common: 47% reported difficulty walking and 24% reported vision loss. About 10% were physically unable to leave their homes and 4% were
bedridden. Most required medical aids such as walking canes and eyeglasses. Diet was inadequate
with older refugees reporting regularly reducing portion sizes, skipping meals, and limiting intake of fruits, vegetables, and meats, often to provide more food to younger family members. Some 61%
of refugees reported feeling anxious, and significant proportions of older persons reported feelings
of depression, loneliness, and believing they were a burden to their families. 74% of older refugees indicated varying degrees of dependency on humanitarian assistance.
Conclusion
The study concluded older refugees from Syria are a highly vulnerable population needing health surveillance and targeted assistance. Programs assisting vulnerable populations may concentrate
services on women and children, leaving the elderly overlooked.
Source: Strong et al. (2015)” Health status and health needs of older refugees from Syria in Lebanon” Conflict
and Health20159:12 https://doi.org/10.1186/s13031-014-0029-y©
https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-014-0029-y (open access) [accessed in
06/12/2017]
90
through appropriate prevention and mitigation mechanisms.[…] These mechanisms include
prevention and management of chronic diseases, work related injuries, road accidents, mental health
problems, and of newly emerging infectious diseases”.
In this chapter, we look specifically at functional disability, which is operationally defined as
difficulty performing one or more activities of daily living (ADLs) or instrumental ADLs (IADLs)70.
“Healthy ageing”, on the other hand, is when an older person maintains the functional ability that
enables well- being.
While it’s difficult to provide insight into the future of disability in the context of Arab countries, in
particular because of improvements in medical research, it’s important to understand the current
situation. ESCWA has published recent data for selected countries from censuses and surveys self-
reported by the interviewed persons. Despite some problems of comparability across countries due to
difference in data collection methods71, we can draw a broad picture on disability in Arab countries,
keeping in mind that it gives only an approximation of disability rates.
Table 7 indicates wide variations in functional dependence among older Arab persons across
countries: the disability rate of people 60 years and over (as defined by the Washington group)
exceeds 25% in Morocco and reaches high levels in Palestine (16.1%), Yemen (15..4%) and Bahrain
(14..1%). In contrast, it is too low in Qatar (3.2%) and Mauritania (4.5%). Normally, disability rates
correlate with the level of human development, which is not the case for Mauritania, probably due to
data quality.
High gender differences in prevalence rates of limitations in activities of daily living (ADL) were
reported in Yemen, Egypt, Morocco and Jordan, while in Bahrain, Mauritania and to a less extent
Saudi Arabia no gender differential in the rate of disability was observed. In all countries, disability
increases with age group.
70Precisely, for ESCWA” Persons with disabilities are defined as those persons who are at greater risk than the general population for experiencing restrictions in performing specific tasks or participating in role activities due to limitations in basic activity functioning, such as walking, seeing, hearing, or remembering even if such limitations were ameliorated by the use of assistive devices, a supportive environment or plentiful resources. Such persons may not experience limitations in specifically measured tasks, such as bathing or dressing, or participation activities, such as working or going to church or shopping, because the necessary adaptations have been made at the person or environmental levels. These persons would still, however, be considered to be at greater risk of restrictions in activities and/or participation than the general population because of the presence of limitations in basic activity functioning, and because the absence of necessary accommodations would jeopardize their current levels of participation”. “For purposes of reporting and generating internationally comparable data, the Washington Group has recommended to use, for each domain four response categories: (1) No, no difficulty, (2) Yes, some difficulty, (3) Yes, a lot of difficulty and (4) Cannot do it at all. The Washington Group has recommended the following cutoff be used to define the population of persons with disabilities:
The sub-population disabled includes everyone with at least one domain that is coded as a lot of difficulty or cannot do it at all.”
71 For more detail, see technical notes for each country in in the ESCWA website: https://www.unescwa.org/sub-site/arab-disability-statistics-2017. See for more detail on the quality of data sources on disability in Arab countries: ESCWA (2014) Disability in the Arab region: an overview. E/ESCWA/SDD/2014/Technical Paper.1. (even if the following study was published in 2014, its findings are still valid)
91
60-69 60+ 70+ 60-69 60+ 70+ 60-69 60+ 70+
Bahrain 10.4 14.1 19.9 10.7 14.1 20.6 10.1 14.1 19.3 2010
Egypt 4.8 7.9 14.8 5.1 7.4 12.9 4.6 8.4 16.7 2016
Iraq 9.5 10.3 15.4 8.6 9.7 14.4 6.6 10.8 16.3 2013
Jordan 8.2 11.9 16.3 7.2 10.4 14.2 9.1 13.3 18.4 2015
Mauritania 3.4 4.5 5.8 3.6 4.7 6.2 3.1 4.2 5.5 2013
Morocco 15.6 25.0 36.8 14.3 22.6 33.8 16.9 27.2 39.4 2014
Oman 7.3 12.6 19.0 7.1 11.9 17.7 7.5 13.4 20.4 2010
Qatar 1.5 3.2 8.1 0.9 2.3 7.3 2.8 4.9 9.1 2010
Saudi Arabia 3.6 6.9 11.9 3.4 6.4 11.0 3.7 7.4 12.8 2016
State of
Palestine10.0 16.1 23.2 9.1 14.9 21.9 10.7 17.1 24.1 2007
Tunisia 69.0Around
2010
Yemen 7.6 15.4 24.0 5.2 13.2 22.0 9.8 17.6 25.9 2014
Table 7: Proportion of Old Persons with Disability by Age and Sex
Country
Source: ESCWA (2017) https://www.unescwa.org/sub-site/arab-disability-statistics-2017. For Tunisia, see
http://www.socialprotection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=48037
Year of
Reference Both sexes Male Female
Percent With Disability (a Lot of Difficulty or Cannot Do it at All)
Disability is believed to be one of the important determinants of future health72. To calculate how
many years of life expectancy old people loose because of disability, we have estimated disability-
free life expectancy (DFLE)73 for some countries. Table 8 presents life expectancy at 60 years and its
components, the DFLE and the number of years expected to be lost in disability. It shows that old
men and women in Qatar enjoy the highest life expectancy at 60 years and the lowest life expectancy
with disability, while in Morocco old men and old women, according to what they have reported,
experience the highest number of years in disability.
Males Females
LE at 60
years
LE(60) With
DisabilitiesDFLE
LE at 60
years)
LE (60) With
DisabilitiesDFLE
Bahrain 2010 2010-2015 18.9 3 15.9 20 3.2 16.9
Egypt 2016 2015-2020 16.3 1.5 14.8 18.8 2.2 16.6
Iraq 2013 2010-2015 16.2 1.6 14.6 18.6 2.1 16.5
Jordan 2015 2015-2020 18.2 2 16.2 20.7 3 17.7
Mauritania 2013 2010-2015 15.8 0.7 15 17 0.7 16.3
Morocco 2014 2010-2015 19.2 4.5 14.7 21 6.1 14.9
Oman 2010 2010-2015 19.3 2.6 16.8 22 3.5 18.5
Qatar 2010 2010-2015 20.1 1.1 19 21.6 1.6 20.1
Saudi Arabia 2016 2015-2020 17.9 1.2 16.7 20.3 1.8 18.5
State of Palestine 2007 2005-2010 17.1 2.6 14.5 19.4 3.5 15.9
Yemen 2014 2010-2015 15.4 1.8 13.6 17.1 2.9 14.2
Country
Reference
Year of
Data on
Reference
Period of the
Life Table
Table 8: Life Expectancy (LE) at 60 Years and the Corresponding Disability-Free Life Expectancy (DFLE)
of Some Arab Countries
Source: Author’s calculation based on the life table of the medium variant of the UN World Population Prospects )2017( Projections
and ESCWA data on disability.
Table 8 indicates that older women are more vulnerable than older men. Except for Bahrain and
Mauritania, the proportion of life expectancy lost because of disability is higher for women than for
72 See for example, Murray, C. JL and Lopez, A.D (2017) “Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study”. The Lancet. Volume 349 Number 9064.
73 It indicate the expected length of life lived without a given impairment or disability. It shows that life expectancy at 60 years
92
men (see Annex 6), probably because they live longer than men but also because generally they have
less access to health services and they are more exposed to ill health due to pregnancies and poor
nutrition. The same table shows that old women in Morocco as well as in Palestine, Yemen and Oman
suffer the most from the impact of disability: they have lived a higher proportion of their elderly life
(after 60 years) with a disability than women of other countries.
According to the World Report on Disability 2011, “in the years ahead, disability will be an even
greater concern because its prevalence is on the rise. This is due to ageing populations and the higher
risk of disability in older people as well as the global increase in chronic health conditions such as
diabetes, cardiovascular disease, cancer and mental health disorders”.
To establish a broad estimate about the number of the old persons that might suffer from a disability
in the future, a simple and hypothetical approach is to apply the observed rate of older people’s
disability, which stands as a measure of health and function, to the projected number of persons 60
years and older. The result of this hypothetical exercise, assuming a constant rate of disability as
estimated according to last available data, is presented in table 9. Two other scenarios are presented
in this table, one assuming an increase of the last observed rate by 10% and the other based on a
reduction of this rate by 10%. This exercise shows that, by 2030, the number of older persons who
might suffer from a disability will increase rapidly. For example, from 2015 to 2030, it will increase
by 167% for males in Saudi Arabia in the case of constant rate, by 195% if this rate increases by 10%
or by about 142% if it decreases by 10%.
93
Senario
Country Males Females Males Females Males Females
2010 3 3 3 3 3 3
2030 13 10 15 11 16 12
2050 27 19 33 24 40 29
2016 280 372 280 372 280 372
2030 363 480 403 534 444 587
2050 660 859 815 1061 986 1284
2013 74 98 74 98 74 98
2030 122 173 136 192 149 212
2050 266 357 329 441 398 533
2015 25 35 25 35 25 35
2030 44 60 49 67 54 73
2050 89 121 110 150 133 181
2016 65 55 65 55 65 55
2030 157 108 174 121 192 133
2050 296 275 366 340 443 411
2014 357 478 357 478 357 478
2030 623 828 693 920 762 1012
2050 931 1303 1149 1608 1390 1946
2010 8 7 8 7 8 7
2030 28 19 31 21 35 23
2050 83 55 103 68 125 82
2010 1 1 1 1 1 1
2030 4 3 5 3 5 3
2050 9 9 11 11 13 13
2007 12 14 12 14 12 14
2030 27 35 30 38 32 42
2050 58 75 72 92 87 112
2014 73 109 73 109 73 109
2030 102 167 114 186 125 204
2050 236 362 291 447 352 541
Source: Author’s calculation based on the data of table 8 and UN - 2017 World Population Prospects,
medium variant.
Constant Rate Increased by 10 %Reduced by 10%
Year
Yemen
State of Palestine
Table 9: Population 60 Years and Older (in Thousands) with Disability in 2030 and 2050
According to Three Scenarios on Rate of Old Person Disability
Qatar
Bahrain
Egypt
Iraq
Saudi Arabia
Oman
Jordan
Morocco
One way to reduce the risk of disability at advanced ages, is physical exercises and good diet to avoid
obesity. A growing literature suggests that obesity in older adults is associated with greater risk of
physical disability. Exercise can help improve memory and reverse muscle loss in older adults –
ultimately helping them to recover from disability and regain independence.
D- Family care to older persons
Traditionally, the majority of elder care is provided by relatives. Nevertheless, demographic and
social trends lead to the weakening of intergenerational ties and solidarity. Indeed, families often face
94
challenges in meeting the care needs of their oldest members, leaving some older adults at risk of
having unmet needs. Social coverage is not widespread and is insufficient to remedy to this shortage
in many settings.
Many scholars argue that declining household size, changing living arrangements, rising female
participation in the formal labour market, intensification of migratory movements, declining fertility
and its correlate decreasing number of siblings, and higher youth unemployment are likely to reduce
family members providing intensive care to older parents. Rapid urbanization and change in life style
are also believed to decrease the availability of family carers and their willingness to care for older
persons74. Given the progress in terms of life expectancy, not only the number of persons who will
reach old age is increasing, but many of them will likely live many years after they reach 60. Since
dependence varies positively with age, demand for long-term care is expected to grow in the future.
Factors that contribute to the nuclearization of the family will persist, as well as urbanization, change
in lifestyle, increasing mobility of society and increased women participation to labor force.
Therefore, family caregiving for older people is expected to have increasing limitations, which may
exacerbate the pressure on the elderly’s extended families and on the public expense to take charge
of elderly persons who do not have families or whose families are vulnerable and cannot provide
support. This is especially true given that, on one hand, nursing homes, when available, are not well
prepared to house chronic old patients, and on the other hand, many elder persons are not covered by
a pension system. Since a majority of workers in Arab countries work outside the formal economy,
in the absence of special efforts to develop social protection schemes for the informal sector many
will enter old age without a pension75.
However, the willingness of family members to provide care may be bolstered by supportive
services (for example, technical assistance in learning new skills, counseling and health services)
and financial incentives like tax exemption, since family caregiving represents financial burden.
As some Arab researchers76 argue, “research is needed for the home caregivers in the Arab countries.
More research must be conducted on home care services and the role of research in studying the
impact, the advantages and disadvantages of home care in the Arab region”.
Certainly, support to families in need, reinforcement of long-term care systems and sustainability of
pension systems are urgently needed.
74 Others argue that “the reduction in the number of family carers will be partly compensated by other factors. Longer co-survival of spouses – especially men – makes the elderly more likely to live with a partner in the future thereby increasing the availability of family support since relatively fewer older people will have no surviving children”.
75 https://www.unfpa.org/sites/default/files/pub-pdf/Older_Persons_Report.pdf
76 Abdelmoneium A.O. and Alharahsheh S.T. (2016) Family Home Caregivers for Old Persons in the Arab Region:
Perceived Challenges and Policy Implications. Doha International Family Institute, Doha, Qatar
https://file.scirp.org/pdf/JSS_2016012914272086.pdf [accessed on 8/12/2017]
95
E- Pension coverage
As seen above, informal support systems for older persons are increasingly coming under stress,
which is why there is a growing consensus that countries must develop social protection systems
that cover at least the basic needs of all older persons. Pension coverage is one of these systems.
According to a study by ILO77, effective and expected coverage ratio by a pension is very low in Arab
countries as inferred from data on Middle East and North Africa. Indeed, many older women and men
continue working, for as long as they physically can, often in an indecent job. They are then poorly
paid and they perform their work in precarious conditions, because work is the only means of securing
a minimal livelihood.
The old-age pension beneficiaries as a percentage of the population above statutory pension age is
only 37.5% in North Africa and 31.7% in Middle East (weighted by population aged 65 and over),
which are very small proportions compared to 66.1% for the world average. In the future, it may not
improve significantly. If we look at the ratio of active contributors as a percentage of working age
population or as a percentage of the economically active population, we can determine that less than
half of active contributors are projected to benefit from a pension once they attain old-age (table 10).
For example, around 2013, only 23.9% of the working age population (here 15-64) contributed to a
social security pension scheme in North Africa and only 18.6% in the Middle East.
As a Percentage
of Working Age
Population (15-64)
As a Percentage of
Economically
Active Population
As a Percentage
of Working Age
Population (15-64)
As a Percentage
of Economically
Active Population
(Weighted
by Total
Population)
(Weighted by
Population Aged
65 and Over)
North Africa 23.9 47.4 24 47.8 36.7 37.5
Middle East 18.6 37.1 18.4 36.7 29.5 31.7
The World 30.9 41.4 29.7 39.9 51.5 66.1
Table 10: Effective Pension Coverage Ratios, by Region for the Latest Available Year
Sources: ILO Social Protection Department, compilation of national available data collected in national social security
pension schemes. Based on SSA and ISSA, 2012; 2013a; 2013b; 2014; Eurostat, Income and Living Conditions Database; UN
World Population Prospects, 2012 Revision. Link: http://www.social-
protection.org/gimi/gess/RessourceDownload.action?ressource.ressourceId=44420 Updated 01/2014 FB
Regions
Protected Persons (Active Contributors) Actual Beneficiaries
Active Contributors (Weigted by
Working Age Population )
Active Contributors (Weighted by
Total Population )
Old-Age Pension Beneficiaries
as a Percentage of the
Population Above Statutory
Pension Age
However, there is a large variation in pension coverage among Arab countries, as shown in figure 5.
The percentage of population above statutory pensionable age receiving an old age pension ranges
from 4.6% in Sudan and 8.5% in Yemen to 63.6% in Algeria. Available data show that Algeria, Iraq,
Libya and Bahrain have relatively high coverage rate of old age pension, while Sudan, Yemen,
Mauritania and Syria have the lowest. Data are not available for some high-income countries.
77 International Labour Organization (2014) Social protection for older persons: Key policy trends and statistics
http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_310211.pdf
96
Source: ILO
Conclusion
To sum up, it‘s clear that ageing is inevitable. In fact, the elderly of the future are already with us
today. The group of the elderly, defined here as those above 60 years of age, continues to expand at
an accelerating pace and will generate enormous socio-economic pressures as the demand for
healthcare services and old age income increases.
According to the medium variant of UN-projections, approximately 9.5% of the population of Arab
countries will be 60 years old or over by 2030 and 15.1% by 2050, marking a dramatic jump from
almost 6.7% in 2015. The share of those aged 75 years and above, who are at a heightened risk of
dependency, will increase from 1.5% in 2015 to 2.0% in 2030 and to 4% by 2050. With the high
variant demographic scenario, the demographic share of the elderly 75 years old and over will be
1.9% and 3.6% in 2030 and 2050, respectively, and it is projected to be 2.1% and 4.5% respectively
in the case of the low variant.
In all these scenarios, a rapid pace characterizes ageing. For instance, the time for the percentage aged
65 years and over to double from 7 to 14 is expected to be very short, varying from expected 13 years
in Oman to 36 years in Comoros. However, this doubling of the share of 65 years and over will likely
not happen before 2030. It will occur first in Lebanon and Tunisia before 2040; then in Morocco,
Algeria, Libya, Saudi Arabia and, probably, Kuwait before 2050. For all other countries, the
demographic weight of persons aged 65 and over will likely reach 14 percent of the total population
late after 2050. In other words, none of the Arab countries can be qualified as an “aged society” before
2030. As a benchmark78, in 2013, the European Union (28 countries) had an average share of the
elderly 65 years and over of 18.4%, proportion that attains 21.3% in Germany and 25.0% in Japan.
78 OECD (2017), Elderly population (indicator). doi: 10.1787/8d805ea1-en https://data.oecd.org/pop/elderly-population.htm (Accessed on 25 October 2017)
97
It should be highlighted that, in absolute numbers, Arab aged population will likely see an
unprecedented increase, growing from 26,826,000 in 2015 to 49,594,000 in 2030 and to 102,087,000
in 2050 (a multiplication by 3.8 in 35 years or an annual average increase of slightly more than 2
million). It’s this rapid growth that may be difficult to adjust to and requires urgent attention of
policymakers.
As the proportion of the elderly and their absolute number expands, a shift in the disease patterns
from communicable to non-communicable takes place, which itself calls for adapting the health-care
system toward “preventive, promotive, curative and rehabilitative aspects of health”.
In parallel, fertility is decreasing, leading to a reduction in the number of siblings, which makes it
harder for children to look after their parents compared to past periods of high fertility when families
were more numerous and could share responsibilities. Women are increasingly engaged in economic
activity outside the home, young people are often forced to prolong their schooling, and as a result,
few family members are able to care for dependent members, especially given that Arab families are
gradually becoming nuclear. Thus, family members may find it increasingly difficult to balance work
or school lives with care responsibilities. Therefore, policies should aim to provide affordable,
accessible and quality care services (e.g. day care, supplementary home-based care) for those who
are in need of such services, especially women. In this regard, it’s important that training should be
available for family carers, in particular for those who have older family members with dementia.
Simultanously, policies should support families providing care for older persons and promote
intergenerational and intra-generational solidarity.
The undergoing socio-demographic change coincides for many families with high levels of poverty,
unemployment and underemployment of their members, or armed conflicts that have affected some
Arab countries. Care of dependent old persons is also difficult to cope with financially, in particular
when the older person has a chronic disease for which associated expenses are not covered by
insurance.
It’s true that important progress has been made in providing access to health care in many Arab
countries, giving access to a basic package of health services to those who are not insured. However,
more efforts should be done so people 60 years and above and their families will not be vulnerable to
catastrophic out-of-pocket payments. Furthermore, geriatric beds or geriatric professionals are much
needed in most Arab countries, specifically at local level.
Old persons’ vulnerability is also exacerbated by illiteracy, which currently affects the majority of
them. As seen in this chapter, in the future, their level of education will certainly improve, but not
enough. A large fraction of them will still likely be uneducated, and hence will be exposed to
vulnerability and to a deficiency of social integration. Reinforcing advocacy and information
campaigns may be necessary to encourage both men and women to achieve literacy, numeracy and
to learn skills in the framework of friendly programs of “education, lifelong learning for acquisition
and retention”79.
A life in dignity requires that older people can ensure a minimum income to survive. However,
available statistics indicates that few of them receive a pension. Even those with a pension, in reality,
except maybe for CCG, will likely not receive enough to ensure a life in dignity and good health.
79 http://unesdoc.unesco.org/images/0024/002470/247039e.pdf
98
Additionally to improving pensions and health insurance systems, social support programs should be
administered, particularly for women and persons with disability.
By adopting the Madrid Plan, governments agreed for the first time on the need to link ageing with
human rights. However data show urgent need for policies and services to guarantee the inherent
dignity of older persons and to ensure their enjoyment of all their rights.
All actions for promoting the wellbeing of old persons should be coordinated by pursuing ageing-
related policymaking in a holistic manner, designing an overarching strategy that could provide
general direction to all entities concerned. A coordinated long-term care and participating approach
is crucial to address older people’s needs and to create a clear picture of all categories concerned and
their specificities, including older refugees, elderly persons in rural areas, widowed women, isolated
persons, homeless persons, etcetera. To do so, it’s of great importance to encourage data collection
and monitoring and evaluating. This requires the continuous improvement of the availability of high
quality age and sex-disaggregated statistical data. To achieve this, human resource capacities in data
collection and analysis need to be further strengthened. ESCWA is a key actor in this respect. It may
continue to strengthen the regional cooperation in this field, in particular by preparing a “standard
set of common survey instruments, harmonized definitions and measurements, and comparable
social, economic and health indicators”80.
80 Sibai AM, Rizk A, Kronfol KM (2014). Ageing in the Arab Region: Trends, Implications and Policy options. The United Nations Population Fund (UNFPA), Economic and Social Commission of Western Asia (ESCWA) and the Center for Studies on Ageing (CSA). Beirut, Lebanon.
http://www.csa.org.lb/cms/assets/csa%20publications/unfpa%20escwa%20regional%20ageing%20overview_full_reduced.pdf
99
Annex
2015 2030 2050 2015 2030 2050 2015 2030 2050
Medium variant 2.8 2.2 3.9 -96.6 -50.0 -48.8 75.8 78.9 82.3
High variant 2.8 2.7 4.9 -96.6 -50.0 -48.8 75.8 78.9 82.3
Low variant 2.8 1.7 1.5 -96.6 -50.0 -48.8 75.8 78.9 82.3
Constant-mortality 2.8 2.2 3.9 -96.6 -50.0 -48.8 75.8 75.8 75.8
Medium variant 2.1 1.8 3.3 138.5 47.5 19.5 76.8 78.8 81.4
High variant 2.1 2.3 4.3 138.5 47.5 19.5 76.8 78.8 81.4
Low variant 2.1 1.3 1.2 138.5 47.5 19.5 76.8 78.8 81.4
Constant-mortality 2.1 1.8 3.3 138.5 47.5 19.5 76.8 76.8 76.8
Medium variant 4.4 3.5 5.6 -10.0 -10.0 -9.8 63.4 66.3 69.1
High variant 4.4 4.0 6.6 -10.0 -10.0 -9.8 63.4 66.3 69.1
Low variant 4.4 3.0 2.3 -10.0 -10.0 -9.8 63.4 66.3 69.1
Constant-mortality 4.4 3.5 5.6 -10.0 -10.0 -9.8 63.4 63.4 63.4
Medium variant 2.9 2.3 3.8 5.3 4.5 4.4 62.1 65.0 68.0
High variant 2.9 2.8 4.8 5.3 4.5 4.4 62.1 65.0 68.0
Low variant 2.9 1.8 1.4 5.3 4.5 4.4 62.1 65.0 68.0
Constant-mortality 2.9 2.3 3.8 5.3 4.5 4.4 62.1 62.1 62.1
Medium variant 3.3 2.7 4.6 -275.0 -225.0 -219.4 71.3 73.8 76.7
High variant 3.3 3.2 5.6 -275.0 -225.0 -219.4 71.3 73.8 76.7
Low variant 3.3 2.2 1.8 -275.0 -225.0 -219.4 71.3 73.8 76.7
Constant-mortality 3.3 2.7 4.6 -275.0 -225.0 -219.4 71.3 71.3 71.3
Medium variant 4.4 3.7 6.1 251.4 -56.2 -29.3 69.7 72.0 74.7
High variant 4.4 4.2 7.1 251.4 -56.2 -29.3 69.7 72.0 74.7
Low variant 4.4 3.2 2.5 251.4 -56.2 -29.3 69.7 72.0 74.7
Constant-mortality 4.4 3.7 6.1 251.4 -56.2 -29.3 69.7 69.7 69.7
Medium variant 3.4 2.7 4.3 487.6 -295.0 -19.5 74.2 76.3 79.0
High variant 3.4 3.2 5.3 487.6 -295.0 -19.5 74.2 76.3 79.0
Low variant 3.4 2.2 1.7 487.6 -295.0 -19.5 74.2 76.3 79.0
Constant-mortality 3.4 2.7 4.3 487.6 -295.0 -19.5 74.2 74.2 74.2
Medium variant 2.0 1.9 3.6 385.0 65.0 43.9 74.6 76.3 78.8
High variant 2.0 2.4 4.6 385.0 65.0 43.9 74.6 76.3 78.8
Low variant 2.0 1.4 1.3 385.0 65.0 43.9 74.6 76.3 78.8
Constant-mortality 2.0 1.9 3.6 385.0 65.0 43.9 74.6 74.6 74.6
Medium variant 1.7 1.7 3.4 550.0 -310.0 -19.5 79.4 82.0 85.2
High variant 1.7 2.2 4.4 550.0 -310.0 -19.5 79.4 82.0 85.2
Low variant 1.7 1.2 1.2 550.0 -310.0 -19.5 79.4 82.0 85.2
Constant-mortality 1.7 1.7 3.4 550.0 -310.0 -19.5 79.4 79.4 79.4
Medium variant 2.3 1.9 3.5 -221.7 -10.0 -9.7 71.9 74.1 76.8
High variant 2.3 2.4 4.5 -221.7 -10.0 -9.7 71.9 74.1 76.8
Low variant 2.3 1.4 1.3 -221.7 -10.0 -9.7 71.9 74.1 76.8
Constant-mortality 2.3 1.9 3.5 -221.7 -10.0 -9.7 71.9 71.9 71.9
Medium variant 4.7 3.9 6.3 32.8 15.3 14.9 63.0 65.1 67.4
High variant 4.7 4.4 7.3 32.8 15.3 14.9 63.0 65.1 67.4
Low variant 4.7 3.4 2.7 32.8 15.3 14.9 63.0 65.1 67.4
Constant-mortality 4.7 3.9 6.3 32.8 15.3 14.9 63.0 63.0 63.0
Medium variant 2.5 2.1 3.8 -282.1 -257.1 -250.7 75.5 78.9 82.6
High variant 2.5 2.6 4.8 -282.1 -257.1 -250.7 75.5 78.9 82.6
Low variant 2.5 1.6 1.4 -282.1 -257.1 -250.7 75.5 78.9 82.6
Constant-mortality 2.5 2.1 3.8 -282.1 -257.1 -250.7 75.5 75.5 75.5
Annex 1: Fertility, Mortality and Migration Hypotheses for Arab Countries According to the United
Nations World Population Prospects (2017)
Iraq
Jordan
Lebanon
Kuwait
CountryTotal Fertility RateNumber of Migrants (in Thousands)Life Expectancy at Birth (Years)
Variant
Egypt
Algeria
Bahrain
Comoros
Djibouti
Morocco
Mauritania
Libya
100
2015 2030 2050 2015 2030 2050 2015 2030 2050
Medium variant 2.7 2.0 3.5 711.3 30.0 19.5 76.8 80.1 83.8
High variant 2.7 2.5 4.5 711.3 30.0 19.5 76.8 80.1 83.8
Low variant 2.7 1.5 1.2 711.3 30.0 19.5 76.8 80.1 83.8
Constant-mortality 2.7 2.0 3.5 711.3 30.0 19.5 76.8 76.8 76.8
Medium variant 1.9 1.7 3.3 401.0 95.0 58.5 78.0 80.3 83.3
High variant 1.9 2.2 4.3 401.0 95.0 58.5 78.0 80.3 83.3
Low variant 1.9 1.2 1.1 401.0 95.0 58.5 78.0 80.3 83.3
Constant-mortality 1.9 1.7 3.3 401.0 95.0 58.5 78.0 78.0 78.0
Medium variant 2.6 2.1 3.5 1090.0 300.0 195.0 74.4 76.6 79.6
High variant 2.6 2.6 4.5 1090.0 300.0 195.0 74.4 76.6 79.6
Low variant 2.6 1.6 1.3 1090.0 300.0 195.0 74.4 76.6 79.6
Constant-mortality 2.6 2.1 3.5 1090.0 300.0 195.0 74.4 74.4 74.4
Medium variant 6.4 5.0 7.4 -213.3 -149.8 -146.1 55.9 61.5 66.8
High variant 6.4 5.5 8.4 -213.3 -149.8 -146.1 55.9 61.5 66.8
Low variant 6.4 4.5 3.2 -213.3 -149.8 -146.1 55.9 61.5 66.8
Constant-mortality 6.4 5.0 7.4 -213.3 -149.8 -146.1 55.9 55.9 55.9
Medium variant 4.1 3.2 5.2 -38.3 -25.0 -24.4 73.3 75.8 78.7
High variant 4.1 3.7 6.2 -38.3 -25.0 -24.4 73.3 75.8 78.7
Low variant 4.1 2.7 2.1 -38.3 -25.0 -24.4 73.3 75.8 78.7
Constant-mortality 4.1 3.2 5.2 -38.3 -25.0 -24.4 73.3 73.3 73.3
Medium variant 4.6 3.8 6.1 -419.7 -50.0 -48.8 64.2 67.3 70.5
High variant 4.6 4.3 7.1 -419.7 -50.0 -48.8 64.2 67.3 70.5
Low variant 4.6 3.3 2.5 -419.7 -50.0 -48.8 64.2 67.3 70.5
Constant-mortality 4.6 3.8 6.1 -419.7 -50.0 -48.8 64.2 64.2 64.2
Medium variant 3.0 2.4 3.9 -2698.9 715.0 -48.7 70.6 78.3 81.0
High variant 3.0 2.9 4.9 -2698.9 715.0 -48.7 70.6 78.3 81.0
Low variant 3.0 1.9 1.4 -2698.9 715.0 -48.7 70.6 78.3 81.0
Constant-mortality 3.0 2.4 3.9 -2698.9 715.0 -48.7 70.6 70.6 70.6
Medium variant 2.2 2.0 3.7 -43.0 -20.0 -19.5 75.6 78.3 81.6
High variant 2.2 2.5 4.7 -43.0 -20.0 -19.5 75.6 78.3 81.6
Low variant 2.2 1.5 1.4 -43.0 -20.0 -19.5 75.6 78.3 81.6
Constant-mortality 2.2 2.0 3.7 -43.0 -20.0 -19.5 75.6 75.6 75.6
Medium variant 1.8 1.6 3.3 390.5 275.0 243.8 77.1 79.4 82.5
High variant 1.8 2.1 4.3 390.5 275.0 243.8 77.1 79.4 82.5
Low variant 1.8 1.1 1.1 390.5 275.0 243.8 77.1 79.4 82.5
Constant-mortality 1.8 1.6 3.3 390.5 275.0 243.8 77.1 77.1 77.1
Medium variant 4.1 2.9 4.2 -112.5 -135.0 -97.5 64.7 67.5 70.4
High variant 4.1 3.4 5.2 -112.5 -135.0 -97.5 64.7 67.5 70.4
Low variant 4.1 2.4 1.6 -112.5 -135.0 -97.5 64.7 67.5 70.4
Constant-mortality 4.1 2.9 4.2 -112.5 -135.0 -97.5 64.7 64.7 64.7
Annex 1: Fertility, Mortality and Migration Hypotheses for Arab Countries According to the United Nations
World Population Prospects (2017) - Continued
Country VariantTotal Fertility Rate
Yemen
United Arab Emirates
Tunisia
Syrian Arab Republic
State of Palestine
Somalia
Saudi Arabia
Qatar
Sudan
Number of Migrants (in Thousands)Life Expectancy at Birth (Years)
Oman
101
2015 2030 2050 2015 2030 2050
Medium variant 3564 6478 13222 926 1718 4062
High variant 3564 6478 13222 926 1718 4062
Low variant 3564 6478 13222 926 1718 4062
Constant-mortality 3564 6254 11819 926 1592 3217
Medium variant 57 185 405 10 25 126
High variant 57 185 405 10 25 126
Low variant 57 185 405 10 25 126
Constant-mortality 57 179 353 10 22 93
Medium variant 37 64 133 7 11 24
High variant 37 64 133 7 11 24
Low variant 37 64 133 7 11 24
Constant-mortality 37 63 122 7 10 21
Medium variant 57 103 203 11 19 43
High variant 57 103 203 11 19 43
Low variant 57 103 203 11 19 43
Constant-mortality 57 101 192 11 19 39
Medium variant 7226 11831 23689 1518 2499 5612
High variant 7226 11831 23689 1518 2499 5612
Low variant 7226 11831 23689 1518 2499 5612
Constant-mortality 7226 11305 20453 1518 2265 4071
Medium variant 1812 3172 7454 375 627 1661
High variant 1812 3172 7454 375 627 1661
Low variant 1812 3172 7454 375 627 1661
Constant-mortality 1812 3096 6775 375 594 1355
Medium variant 506 970 2178 115 180 595
High variant 506 970 2178 115 180 595
Low variant 506 970 2178 115 180 595
Constant-mortality 506 936 1940 115 164 460
Medium variant 160 588 1158 21 64 358
High variant 160 588 1158 21 64 358
Low variant 160 588 1158 21 64 358
Constant-mortality 160 571 1009 21 57 259
Medium variant 671 1022 1688 188 299 601
High variant 671 1022 1688 188 299 601
Low variant 671 1022 1688 188 299 601
Constant-mortality 671 973 1457 188 268 435
Medium variant 402 806 1848 98 144 491
High variant 402 806 1848 98 144 491
Low variant 402 806 1848 98 144 491
Constant-mortality 402 783 1662 98 133 392
Medium variant 206 377 789 37 61 147
High variant 206 377 789 37 61 147
Low variant 206 377 789 37 61 147
Constant-mortality 206 372 749 37 59 132
Medium variant 3464 6435 10977 833 1519 3642
High variant 3464 6435 10977 833 1519 3642
Low variant 3464 6435 10977 833 1519 3642
Constant-mortality 3464 6154 9405 833 1345 2493
Libya
Mauritania
Morocco
Kuwait
Lebanon
Annex 2 : Population (in Thousands) 60 Years and Older and Population 75 Years and Older by UN
Projection Scenarios
Country Variants
Algeria
Bahrain
Comoros
60+ 75+
Djibouti
Egypt
Iraq
Jordan
102
2015 2030 2050 2015 2030 2050
Medium variant 161 422 1373 34 76 345
High variant 161 422 1373 34 76 345
Low variant 161 422 1373 34 76 345
Constant-mortality 161 401 1175 34 68 243
Medium variant 58 278 689 9 31 216
High variant 58 278 689 9 31 216
Low variant 58 278 689 9 31 216
Constant-mortality 58 270 602 9 28 162
Medium variant 1653 4356 10323 312 672 2895
High variant 1653 4356 10323 312 672 2895
Low variant 1653 4356 10323 312 672 2895
Constant-mortality 1653 4192 9000 312 604 2130
Medium variant 602 962 1883 102 180 353
High variant 602 962 1883 102 180 353
Low variant 602 962 1883 102 180 353
Constant-mortality 602 937 1696 102 173 309
Medium variant 211 423 1022 41 82 244
High variant 211 423 1022 41 82 244
Low variant 211 423 1022 41 82 244
Constant-mortality 211 408 901 41 75 184
Medium variant 2078 3544 6700 410 718 1465
High variant 2078 3544 6700 410 718 1465
Low variant 2078 3544 6700 410 718 1465
Constant-mortality 2078 3505 6383 410 708 1386
Medium variant 1192 2486 5461 277 547 1503
High variant 1192 2486 5461 277 547 1503
Low variant 1192 2486 5461 277 547 1503
Constant-mortality 1192 2339 4517 277 488 1046
Medium variant 1316 2273 3675 355 556 1217
High variant 1316 2273 3675 355 556 1217
Low variant 1316 2273 3675 355 556 1217
Constant-mortality 1316 2165 3142 355 497 867
Medium variant 179 896 2461 22 80 770
High variant 179 896 2461 22 80 770
Low variant 179 896 2461 22 80 770
Constant-mortality 179 867 2137 22 73 579
Medium variant 1213 1921 4758 213 370 727
High variant 1213 1921 4758 213 370 727
Low variant 1213 1921 4758 213 370 727
Constant-mortality 1213 1882 4417 213 358 635
Medium variant 26826 49594 102087 5915 10477 27096
High variant 26826 49594 102087 5915 10477 27096
Low variant 26826 49594 102087 5915 10477 27096
Constant-mortality 26826 47753 89907 5915 9601 20508
Sudan
Yemen
Arab Region
United Arab Emirates
Tunisia
Syrian Arab Republic
Annex 2 : Population (in Thousands) 60 Years and Older and Population 75 Years and Older by UN
Projection Scenarios - Continued
State of Palestine
Somalia
Oman
Qatar
Saudi Arabia
Country Variants 60+ 75+
103
2015 2030 2050
Medium variant 2.3 3.5 7.1
High variant 2.3 3.4 6.4
Low variant 2.3 3.7 7.9
Constant-mortality 2.3 3.3 5.8
Medium variant 0.7 1.2 5.4
High variant 0.7 1.2 4.9
Low variant 0.7 1.3 5.9
Constant-mortality 0.7 1.1 4.1
Medium variant 0.9 1.0 1.6
High variant 0.9 1.0 1.5
Low variant 0.9 1.1 1.8
Constant-mortality 0.9 1.0 1.5
Medium variant 1.2 1.7 3.3
High variant 1.2 1.6 2.9
Low variant 1.2 1.8 3.7
Constant-mortality 1.2 1.7 3.1
Medium variant 1.6 2.1 3.7
High variant 1.6 2.0 3.3
Low variant 1.6 2.2 4.1
Constant-mortality 1.6 1.9 2.8
Medium variant 1.0 1.2 2.0
High variant 1.0 1.1 1.8
Low variant 1.0 1.2 2.3
Constant-mortality 1.0 1.1 1.7
Medium variant 1.3 1.6 4.2
High variant 1.3 1.6 3.8
Low variant 1.3 1.7 4.7
Constant-mortality 1.3 1.5 3.3
Medium variant 0.5 1.3 6.3
High variant 0.5 1.3 5.7
Low variant 0.5 1.4 7.0
Constant-mortality 0.5 1.2 4.7
Medium variant 3.2 5.6 11.1
High variant 3.2 5.3 9.9
Low variant 3.2 5.9 12.6
Constant-mortality 3.2 5.0 8.5
Medium variant 1.6 2.0 6.1
High variant 1.6 1.9 5.4
Low variant 1.6 2.0 6.8
Constant-mortality 1.6 1.8 5.0
Medium variant 0.9 1.0 1.6
High variant 0.9 1.0 1.5
Low variant 0.9 1.0 1.8
Constant-mortality 0.9 1.0 1.5
Medium variant 2.4 3.7 8.0
High variant 2.4 3.6 7.2
Low variant 2.4 3.9 8.9
Constant-mortality 2.4 3.3 5.7
Percent 75+
Egypt
Lebanon
Libya
Mauritania
Morocco
Iraq
Jordan
Kuwait
Annex 3: Proportion of the Population 75 Years and Older by UN Projection
Scenarios
Algeria
Bahrain
Comoros
Djibouti
Country Variants
104
2015 2030 2050
Medium variant 0.8 1.3 5.1
High variant 0.8 1.3 4.7
Low variant 0.8 1.3 5.6
Constant-mortality 0.8 1.2 3.8
Medium variant 0.3 0.9 5.7
High variant 0.3 0.9 5.3
Low variant 0.3 1.0 6.2
Constant-mortality 0.3 0.9 4.4
Medium variant 1.0 1.7 6.4
High variant 1.0 1.6 5.8
Low variant 1.0 1.8 7.1
Constant-mortality 1.0 1.5 4.9
Medium variant 0.7 0.8 1.0
High variant 0.7 0.8 0.9
Low variant 0.7 0.9 1.1
Constant-mortality 0.7 0.8 1.0
Medium variant 0.9 1.2 2.5
High variant 0.9 1.2 2.3
Low variant 0.9 1.3 2.8
Constant-mortality 0.9 1.1 1.9
Medium variant 1.1 1.3 1.8
High variant 1.1 1.3 1.7
Low variant 1.1 1.4 2.0
Constant-mortality 1.1 1.3 1.8
Medium variant 1.5 2.1 4.4
High variant 1.5 2.0 4.0
Low variant 1.5 2.1 4.9
Constant-mortality 1.5 1.9 3.3
Medium variant 3.1 4.3 8.8
High variant 3.1 4.2 7.9
Low variant 3.1 4.5 9.8
Constant-mortality 3.1 3.9 6.6
Medium variant 0.2 0.7 5.8
High variant 0.2 0.7 5.4
Low variant 0.2 0.7 6.3
Constant-mortality 0.2 0.7 4.5
Medium variant 0.8 1.0 1.5
High variant 0.8 1.0 1.4
Low variant 0.8 1.0 1.7
Constant-mortality 0.8 1.0 1.4
Medium variant 1.5 2.0 4.0
High variant 1.5 1.9 3.6
Low variant 1.5 2.1 4.5
Constant-mortality 1.5 1.9 3.2
Tunisia
Yemen
Arab Region
United Arab Emirates
Annex 3: Proportion of the Population 75 Years and Older by UN Projection
Scenarios - Continued
Percent 75+
Syrian Arab Republic
State of Palestine
Sudan
Somalia
Country Variants
Oman
Qatar
Saudi Arabia
105
Total No Education Primary Secondary Post -Secondary Total No Education Primary Secondary Post - Secondary
2015 100.0 43.6 24.4 25.9 6.1 100.0 75.2 13.7 9.9 1.2
2030 100.0 16.7 24.6 50.6 8.1 100.0 46.0 18.8 31.2 4.1
2050 100.0 3.4 10.4 72.1 14.2 100.0 13.6 12.5 57.6 16.4
2015 100.0 15.8 24.2 36.2 23.8 100.0 39.2 23.8 22.7 14.4
2030 100.0 11.1 23.5 45.9 19.4 100.0 14.1 22.4 41.6 21.9
2050 100.0 3.7 15.6 61.0 19.7 100.0 3.1 10.3 53.4 33.1
2015 100.0 73.6 17.0 6.1 3.3 100.0 93.1 4.9 1.7 0.4
2030 100.0 36.3 38.2 16.2 9.3 100.0 62.3 26.2 9.1 2.4
2050 100.0 10.7 48.4 24.1 16.8 100.0 20.0 49.4 23.6 7.0
2015 100.0 46.5 39.5 11.6 2.4 100.0 72.0 23.6 3.7 0.7
2030 100.0 30.7 45.7 19.2 4.3 100.0 54.6 34.3 9.6 1.5
2050 100.0 18.3 46.8 29.2 5.7 100.0 31.4 43.5 22.2 2.9
2015 100.0 45.3 17.8 22.0 15.0 100.0 74.8 9.3 10.2 5.7
2030 100.0 30.1 13.4 38.5 18.1 100.0 58.0 9.2 23.3 9.5
2050 100.0 14.7 8.1 54.9 22.2 100.0 26.8 7.3 47.6 18.3
2015 100.0 31.9 33.3 18.8 16.0 100.0 66.3 21.1 6.7 5.9
2030 100.0 13.4 34.6 27.8 24.2 100.0 36.0 35.9 16.2 12.0
2050 100.0 4.3 29.5 33.3 32.9 100.0 11.6 36.9 27.6 23.9
2015 100.0 24.8 27.6 22.0 25.6 100.0 57.2 20.3 13.5 9.0
2030 100.0 9.9 23.3 33.7 33.0 100.0 22.3 24.6 29.0 24.1
2050 100.0 4.2 13.5 48.3 34.0 100.0 4.5 12.6 42.7 40.2
2015 100.0 13.1 30.4 31.8 24.7 100.0 32.1 28.4 24.9 14.5
2030 100.0 13.9 32.6 32.9 20.6 100.0 16.2 28.7 33.2 21.9
2050 100.0 8.9 24.4 48.6 18.1 100.0 8.1 20.5 43.1 28.3
2015 100.0 14.9 42.4 32.4 10.4 100.0 33.0 34.0 28.9 4.2
2030 100.0 5.9 30.9 45.4 17.8 100.0 12.5 28.5 47.3 11.7
2050 100.0 1.6 19.1 51.2 28.1 100.0 2.6 16.8 53.8 26.8
2015 100.0 53.3 19.4 18.2 9.1 100.0 80.5 9.2 7.3 3.0
2030 100.0 34.6 19.6 33.6 12.2 100.0 61.5 13.0 19.6 5.9
2050 100.0 20.9 16.4 47.1 15.5 100.0 37.0 14.1 36.3 12.6
2015 100.0 58.5 22.6 11.9 6.9 100.0 78.9 14.8 4.2 2.1
2030 100.0 41.1 23.8 22.9 12.2 100.0 63.9 19.8 11.3 5.0
2050 100.0 28.4 20.9 36.3 14.4 100.0 45.2 21.6 24.1 9.1
2015 100.0 63.6 20.1 12.4 3.9 100.0 87.8 7.8 3.7 0.8
2030 100.0 43.8 27.4 20.1 8.7 100.0 71.2 14.1 11.0 3.7
2050 100.0 19.7 32.4 35.1 12.9 100.0 39.8 23.8 27.4 9.1
Country YearMale Female
Algeria
Bahrain
Comoros
Djibouti
Iraq
Jordan
Kuwait
Lebanon
Mauritania
Annex 4: Population by Education Level (in %)
Egypt
Libya
Morocco
Total No Education Primary Secondary Post -Secondary Total No Education Primary Secondary Post - Secondary
2015 100.0 13.7 43.3 25.5 17.5 100.0 38.9 34.2 17.3 9.6
2030 100.0 5.8 35.8 38.1 20.2 100.0 20.4 38.7 27.1 13.7
2050 100.0 3.1 27.8 45.5 23.6 100.0 7.3 34.4 36.6 21.7
2015 100.0 10.7 43.3 20.0 26.0 100.0 30.5 38.9 14.9 15.7
2030 100.0 3.7 46.4 29.2 20.6 100.0 8.5 34.5 23.0 33.9
2050 100.0 2.8 43.8 37.2 16.2 100.0 2.6 24.8 35.0 37.6
2015 100.0 32.0 34.2 18.4 15.5 100.0 75.5 16.9 4.9 2.7
2030 100.0 9.9 27.4 36.2 26.5 100.0 42.1 25.6 18.6 13.7
2050 100.0 1.9 12.5 45.3 40.3 100.0 9.6 14.1 36.0 40.3
2015 100.0 61.8 12.0 21.9 4.3 100.0 91.8 4.2 3.0 1.0
2030 100.0 42.6 14.1 34.7 8.6 100.0 77.8 9.9 11.3 1.0
2050 100.0 29.8 29.1 34.6 6.5 100.0 56.3 26.2 15.6 1.9
2015 100.0 20.3 43.1 22.3 14.2 100.0 71.0 18.8 7.3 3.0
2030 100.0 6.1 34.2 34.2 25.5 100.0 27.1 34.3 28.4 10.2
2050 100.0 1.7 18.8 47.1 32.4 100.0 4.6 23.9 47.8 23.7
2015 100.0 75.7 12.3 7.6 4.3 100.0 91.1 5.6 2.4 1.0
2030 100.0 62.1 12.9 17.7 7.4 100.0 79.7 8.8 8.6 2.9
2050 100.0 44.3 23.0 21.6 11.1 100.0 57.0 18.0 16.5 8.5
2015 100.0 26.0 47.7 14.3 12.0 100.0 60.6 30.3 5.4 3.7
2030 100.0 13.6 47.9 21.6 16.9 100.0 39.0 39.5 12.5 9.0
2050 100.0 7.0 51.2 25.2 16.5 100.0 15.1 48.2 21.4 15.2
2015 100.0 14.5 22.5 36.0 26.9 100.0 32.5 18.5 30.9 18.1
2030 100.0 10.6 26.3 43.4 19.7 100.0 11.3 18.8 44.5 25.4
2050 100.0 6.4 23.5 53.9 16.2 100.0 3.4 12.5 51.2 32.9
2015 100.0 41.7 33.9 18.9 5.5 100.0 79.5 13.1 6.2 1.2
2030 100.0 15.0 42.6 32.5 9.9 100.0 48.1 31.9 16.4 3.6
2050 100.0 3.8 19.4 57.0 19.7 100.0 16.3 21.8 42.7 19.2
2015 100.0 14.0 43.5 25.2 17.3 100.0 38.4 34.5 17.4 9.7
2030 100.0 6.1 35.9 37.6 20.4 100.0 19.9 38.6 27.6 13.9
2050 100.0 2.8 26.5 46.2 24.5 100.0 6.0 32.7 38.0 23.2
2015 100.0 44.5 25.1 19.2 11.2 100.0 74.1 13.9 8.2 3.8
2030 100.0 24.9 25.0 33.9 16.2 100.0 51.7 19.6 20.4 8.4
2050 100.0 11.3 20.4 46.6 21.6 100.0 22.8 19.3 38.2 19.7
Source: Lutz W. Butz W. and KC S. eds. 2014 World Population and Global Human Capital in the 21st Century. Oxford University Press 2014. www.wittgensteincentre.org/dataexplorer/
Annex 4: Population by Education Level (in %) - Continued
State of Palestine
YearMale Female
Country
Yemen
All Arab countries
Sudan
Syrian Arab Republic
United Arab Emirates
Tunisia
Oman
Qatar
Saudi Arabia
Somalia
106
Total No Education Primary Secondary Post -Secondary Total No Education Primary Secondary Post - Secondary
2015 1388 606 338 360 85 1622 1221 222 160 20
2030 2859 477 703 1447 232 3175 1460 597 989 129
2050 6098 205 632 4394 866 6757 922 841 3889 1105
2015 44 7 11 16 10 29 11 7 7 4
2030 194 22 46 89 38 101 14 23 42 22
2050 579 22 90 353 114 282 9 29 151 93
2015 17 13 3 1 1 20 19 1 0 0
2030 31 11 12 5 3 36 22 9 3 1
2050 63 7 31 15 11 71 14 35 17 5
2015 26 12 10 3 1 31 22 7 1 0
2030 43 13 20 8 2 51 28 17 5 1
2050 87 16 41 25 5 99 31 43 22 3
2015 3596 1628 640 791 538 4240 3172 393 434 241
2030 6006 1808 803 2311 1084 7124 4134 654 1662 674
2050 11304 1662 919 6211 2512 13449 3604 986 6395 2463
2015 780 249 260 146 125 1087 721 229 72 64
2030 1444 193 500 402 349 2013 725 722 325 241
2050 4042 172 1193 1346 1331 4692 545 1731 1297 1119
2015 211 52 58 46 54 210 120 43 28 19
2030 367 36 85 124 121 390 87 96 113 94
2050 1080 45 146 522 367 1132 51 143 483 455
2015 86 11 26 27 21 53 17 15 13 8
2030 316 44 103 104 65 178 29 51 59 39
2050 854 76 209 415 154 531 43 109 229 151
2015 228 34 97 74 24 282 93 96 81 12
2030 354 21 109 161 63 483 60 137 229 57
2050 633 10 121 324 178 790 21 133 425 212
2015 248 132 48 45 23 260 209 24 19 8
2030 484 167 95 163 59 553 340 72 108 32
2050 1109 232 182 523 172 1317 488 186 477 166
2015 78 46 18 9 5 101 79 15 4 2
2030 150 61 36 34 18 176 112 35 20 9
2050 318 90 66 115 46 362 164 78 87 33
2015 1480 941 297 184 57 1683 1477 131 62 13
2030 2485 1087 681 500 215 3098 2206 438 339 115
2050 4091 806 1324 1434 526 5601 2228 1331 1533 509
Libya
Mauritania
Morocco
Egypt
Iraq
Jordan
Kuwait
Lebanon
Annex 5: Population by Education Level (in Thousands)
Country YearMale Female
Algeria
Bahrain
Comoros
Djibouti
107
Total No Education Primary Secondary Post -Secondary Total No Education Primary Secondary Post - Secondary
2015 74 10 32 19 13 60 23 21 10 6
2030 248 14 89 94 50 134 27 52 36 18
2050 944 29 262 430 223 372 27 128 136 80
2015 55 6 24 11 14 18 5 7 3 3
2030 363 13 169 106 75 77 7 27 18 26
2050 1250 35 548 465 203 260 7 64 91 98
2015 936 299 320 172 145 771 582 130 38 21
2030 2756 274 756 997 729 1890 796 484 352 259
2050 6334 120 791 2868 2555 5228 504 735 1883 2105
2015 221 137 27 48 10 261 240 11 8 3
2030 364 155 51 126 31 422 329 42 48 4
2050 603 180 175 209 39 689 388 180 108 13
2015 101 21 44 23 14 110 78 21 8 3
2030 202 12 69 69 52 226 61 77 64 23
2050 482 8 90 227 156 526 24 126 252 125
2015 1347 1020 166 102 58 1517 1382 85 36 15
2030 2251 1397 289 398 166 2477 1973 218 213 73
2050 4468 1979 1026 967 496 4959 2826 895 818 420
2015 762 198 363 109 91 824 499 249 44 31
2030 1478 201 708 319 249 1650 643 652 206 149
2050 3028 213 1550 764 501 3503 530 1690 750 533
2015 165 24 37 59 44 53 17 10 16 10
2030 1191 127 313 516 235 358 41 67 159 91
2050 4241 270 998 2288 685 1579 53 198 809 519
2015 591 247 201 111 32 645 513 84 40 8
2030 953 143 406 309 94 1156 556 368 189 42
2050 1747 66 340 996 345 2070 338 452 884 397
2015 525 73 228 133 91 630 242 217 109 61
2030 851 52 306 320 173 1050 209 405 290 146
2050 2258 64 598 1044 553 2600 156 851 988 604
2015 12956 5765 3246 2490 1456 14505 10742 2017 1195 550
2030 25389 6331 6349 8604 4105 26817 13857 5246 5470 2244
2050 55612 6308 11331 25935 12038 56869 12973 10965 21723 11207
Yemen
All Arab countries
Somalia
State of Palestine
Sudan
Syrian Arab Republic
United Arab Emirates
Tunisia
Oman
Qatar
Source: Lutz W. Butz W. and KC S. eds. 2014 World Population and Global Human Capital in the 21st Century. Oxford University Press 2014. www.wittgensteincentre.org/dataexplorer/
Annex 5: Population by Education Level (in Thousands) - Continued
Country YearMale
Saudi Arabia
Female
Males Female
Life Expectancy
e(60)
Life Expectancy
with Disability
Life Expectancy
“With Some or No
Difficulty"
Life Expectancy
e(60)
Life Expectancy
with Disability
Life Expectancy
“With Some or No
Difficulty"
Bahrain 100 16.1 83.9 100 15.7 84.3
Egypt 100 9 91 100 11.5 88.5
Iraq 100 9.7 90.3 100 11.5 88.5
Jordan 100 10.9 89.1 100 14.5 85.5
Mauritania 100 4.7 95.3 100 4.1 95.9
Morocco 100 23.6 76.4 100 29.1 70.9
Oman 100 13.3 86.7 100 16.1 83.9
Qatar 100 5.5 94.5 100 7.2 92.8
Saudi Arabia 100 6.9 93.1 100 8.9 91.1
State of Palestine 100 15.2 84.8 100 18 82
Yemen 100 11.5 88.5 100 16.8 83.2
Country
Annex 6: Share of Disability as a Component of Life Expectancy
Source: Author’s calculation based on the life table of the medium variant of the UN World Population Prospects )2017(
Projections and ESCWA data on disability.
108
Share 60+ T F R a E 0b M ig c Share 60+ T F R a E 0
b M ig c Share 60+ T F R a E 0b M ig c
A lgeria 30% 1.3 85.9 -76 26% 1.8 81.5 -84 21% 2.5 76.4 -43
B ahrain 31% 1.3 88.0 136 28% 1.8 83.8 135 26% 2.4 79.2 87
C o mo ro s 13% 1.5 71.3 -11 10% 2.1 66.8 -13 8% 3 60.7 -7
D jibo uti 18% 1.4 78.8 0 13% 2 67.4 0 11% 2.6 57.9 0
Egypt 24% 1.4 84.6 -285 20% 1.9 80.3 -312 16% 2.5 75.3 -157
Iraq 16% 1.6 85.8 -210 13% 2.1 81.4 -234 9% 3.1 75.7 -125
Jo rdan 20% 1.4 86.6 123 17% 1.9 82.3 153 14% 2.5 77.4 104
Kuwait 28% 1.3 87.8 151 24% 1.7 83.5 171 22% 2.3 79.1 113
Lebano n 32% 1.2 85.5 22 27% 1.6 81.2 27 23% 2.2 76.3 18
Libya 30% 1.3 88.9 -8 25% 1.8 84.6 -8 20% 2.5 79.9 -3
M auritania 14% 1.5 69.9 6 11% 2.1 65.4 8 9% 2.9 59.5 5
M o ro cco 30% 1.2 85.0 -408 25% 1.7 80.7 -466 19% 2.4 75.3 -248
Oman 30% 1.3 87.5 127 27% 1.7 82.7 126 23% 2.4 78.5 104
P alest ine 17% 1.5 86.7 -113 13% 2.1 82.4 -127 10% 3 77.3 -69
Qatar 37% 1.3 90.4 244 38% 1.8 86.3 200 36% 2.3 81.7 138
Saudi A rabia 25% 1.4 86.6 884 21% 1.9 82.4 1044 18% 2.6 77.6 695
So malia 11% 1.8 64.7 -368 8% 2.6 59.8 -436 6% 3.8 53.9 -237
Sudan 14% 1.5 72.1 100 12% 2.1 67.5 124 10% 2.9 61.7 80
Syria 23% 1.3 88.7 -70 19% 1.8 84.4 -73 15% 2.5 79.6 -33
T unisia 35% 1.2 86.3 -7 30% 1.6 82.1 -8 25% 2.2 77.2 -4
U.A .E 35% 1.1 88.7 920 34% 1.5 84.4 850 32% 2 79.9 551
Yemen 11% 1.7 76.0 -264 9% 2.5 71.5 -301 7% 3.5 66 -153
A rab co untries 22% 18% 14%
So urce: Author’s calculation from Wittgenstein Centre for Demography and Global Human Capital )2015(. Wittgenstein Centre Data Explorer Version 1.2. Available at:
http://www.wittgensteincentre.org/dataexplorer
A nnex 7: Share o f the P o pulat io n A ged 60 Years and A bo ve in 2050 B ased o n T hree Scenario s A bo ut F ert ility, M o rtality and M igrat io n
C o ntinuat io n Scenario
N o te : (a) TFR = Total fertility rate
(c) Net number of migrants in 2045-2050 (in thousands)
(b) E0 = Life expectancy at birth for both sexes (in years)
C o untrySustainability Scenario F ragmentat io n Scenario